作　　者： (张雯）; (赵荧）; (王鸿雁）; (邓元）; (曹培龙）; (李晓锋）; (杨喆）;

机构地区： 西安交通大学第一附属医院病理科,西安710061

出　　处： 《诊断病理学杂志》 2017年第8期571-575,580,共6页

摘　　要： 目的探讨胰腺浆液性囊性肿瘤(SCNs)的临床病理特征、诊断与鉴别诊断。方法回顾分析14例SCNs的临床病史、实验室检查及影像学特征、组织病理学及免疫表型特点,并复习相关文献。结果 14例SCNs患者年龄33~74岁,平均年龄55.8岁;均为女性;12例以上腹痛、腹胀为主要症状就诊,2例体检发现;5例伴发肝或肾囊肿。14例SCNs亚型中11例微囊型,2例寡囊型,1例实性;其中1例微囊型腺瘤混有黏液性囊性肿瘤成分。镜下肿瘤由大小不等、单个或数个大囊腔组成,囊壁内衬单层立方上皮,胞质透明,核小而圆、居中,无核仁,无核分裂象,囊腔间由粗大的纤维组织分隔;实性型则呈腺泡样排列或中央有小的囊腔,似实性肿瘤。免疫组化:14例上皮标记物CK7、CK19和EMA均(+),Muc-2均(-);9例inhibin和calponin(+);CEA和Muc-5AC(+)各5例。随访19~49个月,未见复发和转移。结论胰腺SCNs是一种少见的胰腺外分泌部肿瘤,结合临床影像学、组织病理学及免疫组化有助于诊断与鉴别诊断。手术切除肿瘤后预后良好,但因部分原发肿瘤良、恶性难以鉴别,需进行定期随访。 Objective To study the clinicopathological features,diagnosis and differential diagnosis of serous cystic neoplasms（ SCNs） of the pancreas. Methods The clinical manifestation, radiological, histopathological and immunohistochemical features were retrospectively analyzed in 14 cases of SCNs of the pancreas. Related literatures were reviewed. Results The age of patients ranged from 33 to 74 years and the mean age was 55. 8 years. All the patients with SCNs were female. 12 patients presented with abdominal pain,bloating and 2 patients were found at routine physical examination. 5 of 14 patients were found to accompany with cystic disease of the liver or the kidney. The variants in 14 cases of SCNs included micro-cyst type in 12 cases,macro-cyst type in 2 cases and solid type one case. There was a case of serous microcystic adenomas mixed with mucinous cystadenoma. Microscopically,tumors were composed of multiple tiny,unilocular or a few large cysts lined by a single layer of cuboidal or flattened epithelial cells with clear cytoplasm. The nuclei were centrally located and round. Nuclear atypia and mitoses were typically absent. The stroma of the tumor was found to contain thick fibrous tissue. The solid type arranged in small acini with no or less central lumina,resembling to a solid tumor. Immunohistochemically,all 14 SCNs were positive for CK7,CK19,EMA and negative with Muc-2. Staining for inhibin and calponin was present in 9 of 14（ 64. 3%） cases. Both CEA and Muc-5AC staining were present in 2 cases.No recurrence or metastases was detected during follow-up from 19 to 49 months. Conclusion SCNs of the pancreas is a relatively uncommon tumor originated from the pancreatic exocrine gland. Histopathological and immunohistochemical features combined with clinical and radiological findings are helpful in making SCNs diagnosis and differential diagnosis.Pancreatic SCNs carry a good prognosis after surgical removal. But regular follow-up is necessary because pathological examination of the primary tumor is diffi

关 键 词： 胰腺 浆液性囊性肿瘤 临床病理