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目的:探讨胰腺实性-假乳头状肿瘤(SPN)的临床病理学特点、诊断与鉴别诊断及临床生物学行为特点。方法:回顾性分析43例SPN临床病理特征、免疫组化及随访资料。结果:43例SPN中,女性35例,男性8例,年龄9-69岁,平均年龄36.25岁。肿瘤位于胰头10例,胰体尾部24例,胰腺周围9例;肿瘤大小直径3-17cm,平均为6.5cm,切面囊实性。组织学特点:肿瘤细胞围绕纤维血管轴心形成假乳头状结构或实体片状结构。瘤细胞大小较为一致,核圆或卵圆,异型不明显,核分裂象罕见。免疫组化:Vimentin、β-Catenin(核)、CD10、Cyclin D1和PR多为弥漫阳性,而CK-Pan、Syn多为灶性阳性,Ki-67大部分病例示增殖标记<5%,仅1例为30%。随访40例,中位随访时间61个月,均无瘤生存。结论:SPN是一种较为少见的胰腺外分泌肿瘤,好发于年轻女性,临床生物学行为表现缓慢发展过程。组织学上具有相对特异性的表现,免疫组化联合应用Vimentin,β-Catenin,CD10,Cyclin D1和PR等有助于该肿瘤的诊断和鉴别诊断。
Objective: To investigate the clinicopathological features, diagnosis and differential diagnosis of pancreatic solid pseudopapillary tumor (SPN) and its clinical biological behavior. Methods: The clinical and pathological features, immunohistochemistry and follow-up data of 43 cases of SPN were retrospectively analyzed. Results: In 43 cases of SPN, 35 were female and 8 were male, aged 9-69 years, with an average age of 36.25 years. The tumor was located in 10 cases of the head of pancreas, 24 cases of pancreatic body tail and 9 cases of pancreas. The tumor size was 3-17 cm in diameter with an average of 6.5 cm. Histological features: Tumor cells form a pseudopapillary or solid lamellar structure around the axis of the fibrin. Tumor cells are more consistent size, nuclear round or oval, shaped is not obvious, mitotic figures rare. Immunohistochemistry: Vimentin, β-Catenin (nuclear), CD10, Cyclin D1 and PR mostly diffuse positive, and CK-Pan, Syn mostly foci positive, most cases of Ki-67 showed proliferation markers <5%, only 1 case was 30%. Follow-up 40 cases, the median follow-up time of 61 months, no tumor-free survival. Conclusion: SPN is a rare pancreatic exocrine tumor that occurs in young women and shows a slow development of clinical biological behavior. Histologically with a relatively specific performance, immunohistochemistry combined with Vimentin, β-Catenin, CD10, Cyclin D1 and PR and other tumors contribute to the diagnosis and differential diagnosis.