摘要
目的探讨胰腺导管内管状乳头状肿瘤(intraductal tubulopapillary neoplasm,ITPN)的临床病理特征、诊断、鉴别诊断、治疗及预后。方法结合相关文献回顾性分析本院2018年1月收治的1例ITPN伴浸润性癌患者的临床资料、病理组织学及免疫组化特征。结果该例患者符合ITPN伴浸润性癌的诊断标准,ITPN平均发病年龄为55岁(25~79岁),无明显性别差异,主要表现为扩张的胰管内见境界清楚的呈息肉样或实性结节状生长的肿物,常无明显黏液。光镜下见肿瘤由密集排列的小管状腺体组成,大部分区域腺体背靠背,局灶呈管状乳头状生长,可见筛状结构和粉刺样坏死,腺上皮细胞呈立方形伴中-重度非典型性;在导管内肿瘤周围的间质中出现细条索状细胞或成角的腺体时提示存在浸润性癌。肿瘤细胞常表达CK7、CK19、MUC1、MUC6,不表达MUC2、MUC5AC、CgA、Syn、CD56。结论 ITPN是一种少见的胰腺肿瘤,其术前诊断非常困难,影像学上很难与其他囊实性肿瘤鉴别,确诊主要依据病理学形态及免疫表型,治疗首选手术切除,即使伴有浸润性癌,其预后也相对较好。
Objective To summarize the clinicopathological features, diagnosis, differential diagnosis, treatment and prognosis of intraductal tubulopapillary neoplasm（ITPN） in the pancreas. Method The clinical data, histopathology and immunohistochemical characteristics of 1 patient with ITPN with invasive cancer admitted to our hospital in January 2018 were retrospectively analyzed in combination with relevant literature. Result The patient met the diagnostic criteria of ITPN with invasive carcinoma. The average age of ITPN was 55 years（25-79 years old）, and there was no significant gender difference. Grossly, ITPN showed polypoid, solid nodule in the dilated pancreatic duct, often without obvious mucin. Microscopically, the intraductal nodule was composed of tightly packed small tubular glands lined by cuboidal cells with high-grade atypia. Papilla formation was seen in focal area. The sieve-like appearance and comedo-like necrosis were observed. Invasive carcinomas arising in association with ITPNs typically consisted of individual cells or small, angulated nonmucinous glands extending away from the periphery of the involved ducts into the surrounding desmoplastic stroma. Immunohistochemically, tumor cells often expressed CK7, CK19, MUC1 and MUC6, but not MUC2, MUC5 AC, Cg A, Syn and CD56. Conclusion ITPN is a rare pancreatic neoplasm, and difficult to be diagnosed preoperatively. The diagnosis can be made based on histopathology and immunohistochemistry. Currently, surgical resection is the only curative management option for ITPNs. The overall outcome seems to be relatively favorable, even with invasive carcinoma.
作者
陈思敏
王露
高丽丽
王耀辉
黄玉洁
章宜芬
CHEN Si-min;WANG Lu;GAO Li-li;WANG Yao-hui;HUANG Yu-jie;ZHANG Yi-fen(Department of Pathology,Affiliated Hospital of Nanjing University of Traditional Chinese Medicine,Jiangsu Nanjing 210029,China)
出处
《中国医刊》
CAS
2018年第9期1036-1040,共5页
Chinese Journal of Medicine
关键词
胰腺
导管内管状乳头状肿瘤
导管内乳头状黏液性肿瘤
免疫组化
Pancreas
Intraductal tubulopapillary neoplasm
Intraductal papillary mucinous neoplasm
Immunohistochemistry
