[doc格式] 胰腺实性假乳头状瘤临床病理分析

[doc格式] 胰腺实性假乳头状瘤临床病理 胰腺实性假乳头状瘤临床病理分析 2008??5?P?915???914?cJPMT,May.2008,Vol.15,No.14 ???????A?%???h???n?h?????4?4?? ???? 1 ,?+???52 ,?????J3 (1.?????K?????I???Y???0?9?????l?K??,???H?h?1252600; 2.?????2???l?K??,?????R??030012; 3.?????0?B???K??,??????????024000) [????]????:???????????A???%???h???n(SPTP)???h?????4?????>?????;????u0????:4??SPTP??HEu2?>?? ?????;??((PV2000??)????????u0????:4??SPT?B3???x???A,1???U?A,????15????36??,???%????27??,?s?.?% ???y??u0???n???????A,???%????8.6cm,?M?1??,?????A????u0????,???n?p???h???????x???P???o,???????2????, ?L?4?;???4,?0???y?.?’,?L?4????????u0?n?????????????b?????????o?????A?%???h????u01??????????????????u0 ?:?????n????vimentin,a-AT,a-ACT,???4????Syn,CgA,PR??AE1/AE3,EMA,ER?%?h?Au0????:????SPTP?????? ?????A,???M???????h?????4????,???s?J?????P????,?????x???????A???n,?>?????;???x???????????????:???? ????u0 [???d??]???????n;?>???????;??;???. [?B???4????]R735.9[???d?J???2]B[?????;??]1671-5098(2008)14-1819-03 SolidPseudopapillaryTumorofthePancreasAclinicopathologicAnalysisof4Cases ZhOULi1 ,QUChong-xiao2 ,KANGShu-jiao3 (1.TheSecondPeople’sHospitalofTaishanMedicalCollegeinLiaocheng,Linqing,Shandong,252600,China; 2.ThePeople’sHospitalofShanxi,Taiyuan,Shanxi,030012,China; 3.TheCentralHospitalofChifeng,Chifeng,Neimenggu,024000,China) Abstract:ObjectiveTostudytheclinicopathologicandimmunohistochemicalcharacteristicsofsolidpseudopapillary neoplasmofpancreas(SPTP).Methods4casesofSPTPwerestudiedbyusinghistologicHEandimmunohistochemistry (PV2000method).ResultsTherewere3femaleand1malepatientsagedfrom15to36(meanage27)inourcasesthathad norecurrenceafterresection.Thosetumorswerelargerinsize(meandiameter of8.6cm),solidalternatelywithcysticand- circumscribedbycapsule.Histologically,theywerecomposedofpapillaryandmicrocysticsolidstructures,withuniformed populationofcells,Thenuclearwereoval,roundwithoutatypia,andratemitoticfigures.Pseudopapillawithfibrovascular corewasremarkable.Infiltratingintothepancreaticparenchymawereseenin1cases.Immunohistochemistry,Mostcases expressedvimentin,a-AT,a-ACT,lesscasesexpressedSyn,CgA,PRandAE1/AE3,butallcaseswerenegativeforER,E- MA.ConclusionSPTPofthepancreas,preferentiallytoyoungwomen,areuncommontumors.Thereareadistinctclinico- pathologicentityand,thoughahighcureratebysurgicalresection,itisatumoroflowgrademalignant.Immunohistochemi- calstudiessuggestedthattheoriginofSPTistotipotentialprimordialcellsfoundinthedevelopmentoftheembryonicpan- creas. Keywords:Pancreaticneoplasms;Immunohistochemistry;Prognosis ???????A?%???h???n(Solid-PseudopapillaryTumorof Pancreas,SPTP)?s???????l???????????nu01959???pFrantz ???+????[1] u0WHO(2004)???n???????4???4?????D?x?p???2 ?????????????????o???A???????%???h???????T???A???n, ?L?M???b?????A??,???n?:?L?x???A,???(???x???A[2] u0?h?? ?T,???????t?c?;???????A???????M???A?;???4???A?????? ???p??????SPTP [3]u0 ?9?????Y4?????4?????h?????4??????u0 1?????.???? ?O???l??1999??1?P??2007??6?P???s?J???????? ?n?J?9,?y?????J?%,???????????A?%???h?????n((SPTP)4 ??,?y???h?????4?I??,????1??u0?b?M?J?9?%?C4%?B?A?r ??????,?L???????p?h,???v?1??,????u0?>?????;???C?? ????(???C??)???z,?????xV??,??????????T, a-AAT,vimentin,Syn,CgA,EMA,AE1/AE3,ER,PR?%?B?? ?)???B???c?????s?M??????,???f?A???h?A????u0 2???? 2.1?h???I??4??SPTP,3???x???A,1???x?U?A,?????4 ?/?x15??,27??,30??,36??,???%????27??u01???????T?? ???y?0,,3?????O?????????p??u0???s?b??:?????>???????’ 3??,???h1??u04?????1??????CA19-9,CA125,CA50,CEA ?%?R???.?’?%??u03??CT??B???%?????x?1?????????:?q?? ?A????,???M?????4??,?M???A?x?;???A?x,1???<???y?1,?? ?h?1????????????????u0????1a??6a,?R?????y????????u0 2.2???4???2?????? ?A???????n?????A,?????4?/5,,5, ,???%6u0???n?x?4???;???4??,3???G?M???????? 1819???? HE P2000a-A 2.2.1.8cm8cm9.cm 11cm8.cm 2008??5?P?915???914?cJPMT,May.2008,Vol.15,No.14 ???1??,?J???x?????A,???/???????;?b?A????,???A?x????u2 ??????u2?C?u??????,1???????.?w???J??????,?J??????u2?? ??,?????A,?.?????<???:?1u0 2.2.2???????2??????4?????n???????2???????G,???n?p ???A?xu2?%???h?xu2???A?x???P???ou0???A?x?C???????????M ???????????n???????)?o?%??,?n?????????x????????????, ?%???h?x?’?x?????A?????b?????????4?s?????h,???h???? ???4?h?M???????Au0???n?????+?4??u2???4??,???W?u??,???? ?A?;?V?.?+??????,?L?4,?????C??,???.?’?0???A,?L?4???? ????,?n?????????C????????;???A?x???A?V?y?????????? ??,?M???????F????????,?G?b???n?Uu0???;?9??1???n???? ???h?1????????????????,???????.?’?0??,?????????n???? ?.???????????????),?????C????u0?>?????;????????:a-AT ?f?A(3/4),a-ACT?f?A(2/4),vimentin?f?A(3/4),Syn?f?A(1/4), CgA?f?A(1/4),EMA?h?A(0/4),AE1/AE3???C?f?A(1/4),ER ?h?A(0/4),PR?f?A(1/4)u0 3???? 3.1?h??????SPTP?????????????A [4] ,???%????22??,?U ?A??????7%??????,10?????,???q?????l??,40?????T?? ???1???y????10%u0?h???:?????????????????;?????????A ?????x?????????p??,?????h?????????????????y?0????, ??:????u2????u2????u2???ou2???;?y???D;???????L?????x?<?? ?1??????????????,?L?h???A???;?????????x???A,?M?????M ???;u0???n???>???????????????>,?:???>???????;,???M?l ???4?.????????????[5] u0?9????3??,?U1??,???%????27 ??,???????c??????,???B3???C?????’??,1???C???h??,?. ???d???????9????u0 3.2???4?????? 3.2.1???????n???????/???A,???A???x1.5cm??30cm?y ?D,?M???d?K??292??SPTP,?????%???A??10.3cm [6] u0???n?+ ?o???;????,?C??,?V?1???l???????A????,?h?:?l?y?D???? ??,?(?L???.?’???<???1??;?A?1?????x?????A?%?1??,?L?h ???bu2?????????A??u0 3.2.2?????’?x???2????,???0?????n???????)?+?%?????% ???h??,?n???s?????b?????????%???h?????s????SPTP?? ?????J??u0?b?3???%???h?s?J?p?????n????????,???????n?? ???????b?????????)?a???o?????h?U????u0???n?L?????C?? ???h???????????A?????????b????,?????a?????????A?Q??, ???????????????????????????????o?sSPTP???????????Q ??u0???A?x?????A?V?y????????????,?M???????F????????, ???y???,?G?b???n?U,?W??????????????u0 3.2.3?>?????;???d?????>?????;?????5???y?j???a,?:?? ???n????vimentin,a-AT,a-AAT,???4????Syn,CgA,PR?? AE1/AE3,?.?9??????????u0???????.???s,?p???????n???4 ?8???????.?’?????A?’?l,???????1???????x?????n?.???A ???m???????????Au0ER,PR???x???A???m????,?o?x?K???( ??????,?W?????:?x???A???m?????.???n?c???M??,?a?.???? ?o????[] u0 33?c?????<?xu2?????????.??????,?A???M5%??ST ?b??????????[8] ,10%??15%?????????c????[6] ,????SPTP?s ???????????A?????nu0???????????????s?J???;?b???y???A ?J???x?Ku0???A?:?????d?%???u???s?.???.????,?:?M?:???? ?d????,SPTP???1???????c???????????:???A????,???s?. ???K?c?????????????:???w????[5,9] u0?????????????.?????? ?????K?c???o?x?????n?????A????u0?9???M1?????h?1??,?? ??????????????,?J???.????4a???y???;????,?????.???? ?.????????u0 3.4???????cSPTP?????????????????x?O???>?:?y?1??u0 ?????n???>?????;?’?x,?T???A????(AE1/AE3)???x?b???p (+),vimentin?t?/(+),a-AT??a-AAT(+),Syn??CgA?b??(+), ???????M?????;?4?????M???4?????l???T?????????:?l?4?; ????u2?(?M?>?????;?y?a?????????n?????C???2???T?????/, ???x?????n?????y?a????????????????????????,?s?2???? ?n???????M?:?l?4?;??????????u0???>,???M?:?????d???? SPTP????????????????????????[10] ?;?:???????????? [6,11] ?? ?%??,???4?M???????????(??????u0 3.5???/???? 3.5.1???????4?????n???????T,???A?%???h?????n?????A ?x?p?????n?????????????2????,?.???????4?????n???L?? ?G,?O?a,?.?1?:?L?x???????????b?????<?A?Q??,?a?s?M?. ?’???b?????C;?a?(,???A?%???h?????n?A?:?????????????u ?%???h??????u0?>???????;???T,???A?%???h?????na-AT?+ ?b???x?f?AVIM?t?/?f?A,???????4???J??Syn.CgA?+?h ?A????;;NSE?n?1?%?????f?Au0 3.5.2?????????<???????n???c?C?U?A?????A?:,???A?%?? ?h?????n?]?A?:?????????????Au0???????T,?????????<?x?? ?%???h???????a???????????;?V????????,?M???????????A ???x??,?W?????????n?????L?4???????L?.?’u0?>???????;?? ?T,?????????<???M?f??????????????????,?a???A?%???h?? ???n?????????????l?f?Au0 3.5.3?????????n?????1?x10?????,???q??,???????A?% ???h?????n??,???????????????n???/u0???O?????????n???? ?????????A?Q??,?W?s???x?????????????b???????h??????u0 ?????????n?L?????x????????,?????????L????????????,?a VIM?h?Au0 ???8???d: [1]FrantzVK.Tumorofthepancreas[A].AnonymousAtlasofTu morPathology[M].WashingtonDC:ArmedForcesInstituteof Pathology,1959:32-33. [2]KlppelqHrubanR,LuttgesJ.WorldHealthOrganizationClassifi cationofTumors.Pathologyandgeneticsoftumorsofdigestivesys tem[M].Lyon,IARCPress,2000. [3]MendelsohnGPapillaryCystictumorofthepancreas[J].AmJClin Patho1,1992,98(5):476-477. [4]SolciaE,CapellaC.KloppleGTumorsofthepancreas.In:Atlasof tumorpathology[M].WashingtonDC:ArmedForcesInstituteof pathology,1997:120-144. [5]q,SzYGSyf yf3[]GB 1820???? 7 .8PP PasuiouCcoaecJentilPA.olidpseudopapillartumorso thepancreas.Pathologreporto1casesJ.astroenterolClini 2008??5?P?915???914?cJPMT,May.2008,Vol.15,No.14 ol,1999,23(2):207-214. [6]MaoC,CuvendiM,DomenicoDR,etal.Papillarycysticandsolid tumorsofthepancreas:apancreaticembryonictumor?Studiesof threecasesandcumulativereviewoftheworld’sliterature[J]. Surgery,1995,118(5):821-828. [7]BerrettaS,BarbagalloE,Dm]AgataA,etal.Frantzm]ssolidcysticpap illarypancreaticcarcinoma[J].MinervaChir,2001,56(4):413-419. [8]KlimstraDS,WenigBM,HeffessCS.Solid-pseudopapillarytumor ofthepancreas:atypicallycysticcarcinomaoflowmalignantpo tential[J].SeminDiagnPatho1,2002,17(1):66-80. [9]MartinRC,KlimstraDS,BrennanMF,etal.Solid-pseudopapillary tumorofthepancreas:asurgicalenigma[J].AnnSurgOncol,2002,9 (1):35-40. [10]Muller-Hocke-J,ZietzCH,SendelhofertA.Deregulatedexpression ofcellcycle-associatedproteinsinsolidpseudopapillarytumorof thepancreas[J].ModPatho1,2001,14(2):47-53. [11]?2??,????,??????,?D.???????A???%???h???n8???h?????4?4 ??[J].?h???.???????4???z??,2003,19(5):474-475. (?O?q???c:2008-02-15) ?????J?9???b???????>???L?I???????? ?????????????????????? ???’?? (???]?????l?K??,???????]211700) [????]????:?????J?9???b???????>???L?I????(ELISA)????????????????????????(HBsAg)??????u0????:?? ?b??????(Hb)?x142g/L???????????b?????<???b?5?4,?????o10?R?y?aHb????,?4?x????:0.055g/Lu20.111g/Lu2 0.221g/Lu20.443g/Lu20.59g/L?x?9????,0.71g/Lu20.887g/Lu22.130g/L u23.550g/Lu27.10g/L?x?9????u0?????5???y?aHb ?????b???????D????(OD)?Gu0????:?C?9?????B,Hb?%?V??0.71g/L,HBsAgS/CO<1,?????%?x?h?A,?C?9?????B,Hb ?%?A??0.71g/L,HBSAgS/CO>1,?????%?x?f?A,?9?????.?9?????????M?’???????????V?Du0????:?C?J?9???b??,?? ?M?????b???u?????,??,?>??????ELISA????HBsAg???%?f?Au0 [???d??]?????>???L?I????;???b;???????????????? [?B???4????]R512.6+ 2[???d?J???2]B[?????;??]1671-5098(2008)14-1821-02 ????????????????????(HBsAg)?s????????(????????) ???b?1???J??u0HBsAg?f?A???.?????1???u???????????? (HBV)???c??[1] u0???>???C??HBsAg???>??????(EIA)?????? ?M?????????c??,HBsAg?f?A?????xHBV?c????????????u0 ?W?s?????>???L?I????(ELISA)????HBsAg?????????m?? ?:,?1???J?9???bu2?0?bu2?b?1?B??????????u2???????????)?D ?Du0??????u2?z???D???>,???L???u?J?9???b??ELISA?M?? ??,?W???l???????o?????b???y?a?,????ELISA????????, ?Q?????L???????????(??,???????,u0 1?????????? 1.1?????M???????1,?U38??,?????b??2ml,??????Hb?x 142g/L,?C???b?z???????b???????o?????)????,???????5 ????????HBsAgOD?Gu0 1.2?????.?????)???x?xMODEL1575??,???J???xMOD- EL550??,?b?????????4?????x???9?D?ZMEK-8222K??u0 HBsAg?????CELISA???????Q????,???z?p?)???J???c???? ?:?M??????????u0 2???? 2.1??Hb?x142g/L?b?J?9,?C???b?z???????b???????o 0.055g/Lu20.111g/Lu20.221g/Lu20.443g/Lu20.59g/Lu20.71g/L. 0.887g/Lu22.130g/Lu23.550g/Lu27.10g/Lu0???????5???????? HBsAgOD?Gu0????(????1)u0 ??1?y?a???????????b?J?9??????HBsAg?????? 3???? ELISA????HBsAg,???L?:?????%?f?A,?m?o?%?f?A?? ?????:u0?p??LIS???????m?????:,???z???????????t?G ???<???????,,???/?C???b?????V???C??,?y?????b?????b?? ?J?9???b,?-?]?4???????M??????????,?m?o?%?f?A???????? ??u0 ?9?(???’?x,??Hb?????A??0.71g/L??,HBsAgOD?% ?A??5,SO>,?????%?x?f?A,???b?????o?o?? ?A,???????b?J?9BOD?G???o?o???Au0???????V?? 1821???? EA0.10/C1.0Hb HsAgHb