摘要
目的探讨胰腺囊性肿瘤的临床病理特征及免疫组织化学特点,以期提高对胰腺囊性肿瘤的认识。方法复习复旦大学附属中山医院1999—2005年间手术切除的92例胰腺囊性肿瘤的临床病理资料和影像资料,根据2002年 WHO 胰腺肿瘤分类标准将其分类。并采用免疫组织化学EnVision 法,借助一组抗体进行鉴别诊断。结果在92例囊性肿瘤中,发病年龄16～80岁,男33例,女59例。其中,浆液性肿瘤18例,黏液性肿瘤14例,导管内乳头状黏液性肿瘤36例,实性假乳头状肿瘤18例,导管腺癌囊性变4例,胰腺内分泌肿瘤囊性变2例。免疫组织化学检测无特异性标记物可以完全区分各类型,常有交叉和重叠。浆液性囊腺瘤表达 MUC-1,黏液性囊性肿瘤表达 MUC-5AC为主,实性假乳头状肿瘤表达α-抗胰蛋白酶、α-抗胰糜蛋白酶、波形蛋白及孕激素受体,导管内乳头状黏液性腺瘤表达 MUC-2,囊性恶性肿瘤主要表达 MUC-1。结论胰腺各类囊性肿瘤在临床症状、影像学表现、组织形态及免疫表型上均有一定特征,但均无特异性,需结合起来综合判断,才能做出正确诊断,以指导临床治疗和预后判断。
Objective To study the clinicopathologic and immunohistochemical features of cystic neoplasms of the pancreas. Methods Ninety-two cases of cystic neoplasm of pancreas were retrieved from the Department archival file during the period from 1999 to 2005. Histologic features were studied and the tumors were typed according to WHO classification. Immunohistochemistry was also carried out using paraffin-embedded tissues. Results The age of patients ranged from 16 to 80 years. The patients included 33 males and 59 females. The tumors varied from 2 cm to 21 cm in diameter. They consisted of intraductal papillary mucinous neoplasm （36/92）, serous cystic neoplasm （18/92）, solid pseudopapillary tumor （18/ 92）, mucinous cystic neoplasm （14/92）, cystic pancreatic ductal adenocarcinoma （4/92） and cystic pancreatic endocrine neoplasm （2/92）. Immunohistochemical study revealed variable staining patterns, with frequent overlaps between different tumor types. In general, serous cystic neoplasm expressed MUC1, while mucinous cystic neoplasm was positive for MUC-SAC, intraductal papillary mucinous neoplasm for MUC-2 and cystic pancreatic ductal adenocareinoma for MUC-1. On the other hand, solid pseudopapillary tumor expressed alpha-antitrypsin, alpha-antichymotrypsin, vimentin and progesterone receptor. Conclusions Accurate diagnosis of pancreatic cystic neoplasms requires correlation of clinical findings, radiologic examination, histologic features and immunostaining results. Pathologic distinction is important because of different prognostic significance. Two-thirds of pancreatic cystic neoplasms are premalignant or malignant and warrant surgical resection, whereas the remaining one-third （including pseudocyst and serous cystadenoma） are benign and can be treated conservatively.
出处
《中华病理学杂志》
CAS
CSCD
北大核心
2007年第3期160-165,共6页
Chinese Journal of Pathology
基金
上海市科委基金(03JC14021)
关键词
胰腺肿瘤
肿瘤
囊性
黏液性和浆液性
诊断
鉴别
Pancreatic neoplasms
Neoplasms, cystic, mucinous, and serous
Diagnosis, differential
