11例胰腺导管内乳头状瘤的诊治体会

胰腺导管内乳头状瘤（intraductal papillarymucinous neoplasms,IPMN）是一种发生在胰腺主胰管及其主要分支胰管的乳头状绒毛腺瘤,1982年由日本的Takagi等[1]首先报道,以分泌粘液引起主胰管或分支胰管囊性扩张为特征,发病率约占胰腺肿瘤的1%～2%,胰腺囊性肿瘤的10%,可能是胰腺癌的一种特殊类型,我科2000年6月～2010年6月共收治11例胰腺导管内乳头状瘤患者,现将其诊断及治疗总结如下。     

胰腺导管内乳头状黏液瘤手术可切除性的影像学评估

<正>胰腺导管内乳头状黏液性肿瘤(intraductal papillary mucinous neoplasm,IPMN)是胰腺常见的良性肿瘤,但常常伴有浸润性癌。以往的研究显示,不伴有浸润性癌的IPMN与伴有浸润性癌的病例相比,预后明显提高。因此,术前准确预测是否存在浸润性癌对制定治疗计划至关重要,决定是否可以进行外科手术治疗。笔者回顾性分析了20例手术切除的IPMN病例的术前MSCT及MRI资料,探讨影像学表现在预测IPMN手术可切除性应用价值。     

胰腺导管内乳头状黏液性肿瘤的CT诊断

目的探讨胰腺导管内乳头状黏液性肿瘤的CT影像学特点。方法回顾性分析经手术病理证实的6例胰腺导管内乳头状黏液性肿瘤的CT表现，其中男4例，女2例，平均年龄64．6岁。术前6例均行CT检查。结果混合型4例．3例为胰头或钩突分支胰管扩张合并主胰管扩张，1例同时伴有胰颈分支胰管扩张；分支胰管型2例，均位于钩突。CT主要表现为分叶状或葡萄串样囊性病变，其间可见分隔，增强后囊性区域无强化，囊壁和分隔可强化。结论胰腺导管内乳头状黏液性肿瘤有相对特征性的影像学表现，CT对其诊断有重要价值。     

胰腺导管内乳头状黏液性肿瘤1例报道

胰腺导管内乳头状黏液性肿瘤是一类以胰腺导管上皮乳头样增生和分泌大量黏液为特点的肿瘤,大量黏液堵塞主胰管或分支胰管并使之扩张。近年来,随着影像学技术的快速发展,使得该疾病的检出率提高,为加强对该病的认识,提高诊断符合率,现将作者在近期工作中遇到的1例该病患者资料报道如下。     

壶腹部肿瘤的术后护理

近年来,壶腹部肿瘤的发病率逐年上升.肿瘤可压迫胆总管和主胰管而使其梗阻,临床多有黄疸、发热、腹痛、纳差、乏力、消瘦等症状.治疗一般行胰、十二指肠切除.     

局部切除治疗十二指肠乳头肿瘤

<正>十二指肠乳头肿瘤,是指发生在十二指肠乳头区域的肿瘤,包括乳头内胆管和胰管的肿瘤,发生率低,以往对于此种肿瘤多采用胰十二指肠切除术,近年来国内外作者采用局部切除治疗此类肿瘤,取得了良好疗效。笔者所在医院2001-09～2007-01施行局部切除治疗十二指肠乳头部肿瘤12例,现报告如下。     

胰腺内分泌肿瘤的诊治探讨

胰腺内分泌肿瘤是一种少见的肿瘤,它可发生于胰岛,也可以起源于腺泡和胰管之间的内分泌细胞。在临床上表现多有与某一激素过量分泌相关的症候群,多被误诊或漏诊,多数医院与医师对此缺乏足够认识,极有必要提高胰腺内分泌肿瘤的认识和诊疗水平。     

胰腺内分泌肿瘤诊治的探讨

目的探讨胰腺内分泌肿瘤(PET)的最新诊治方法,提高对胰腺内分泌肿瘤的认识和诊疗水平。胰腺内分泌肿瘤是一种胰腺内部少见的肿瘤,发病率较低,但具有恶变行,常发生于胰岛,也可以起源于腺泡和胰管之间的内分泌细胞。方法对临床的资料进行总结和分析。结论只有早期明确诊断、提高有效治疗才是提高胰腺内分泌肿瘤患者生存率和术后恢复率的关键。     

关于胰管结石诊治研究分析(附16例报告)

目的针对性分析胰管结石的诊断和外科治疗手段。方法选择我院收治的16例胰管结石患者,通过对其病因、合并症的情况、胰管结石的分布及胰管狭窄部位和程度进行分析,选择不同的手术方式。结果对治疗的患者进行1～5年随访,完全缓解11例(68.8%),部分缓解3例(18.8%)。1例胰腺癌患者术后3年死于癌复发并广泛转移。结论影像学检查是确诊胰管结石的主要方法。胰管结石一经确诊后应根据合并疾病的不同、胰管结石分布以及胰管狭窄情况尽早进行手术治疗。其中以胰管切开取石,胰管空肠Roux-en-Y吻合术为胰管结石的主要术式。     

口服枸橼酸铁铵在磁共振胰胆管造影检查技术中的应用

磁共振胰胆管造影(magneticresonancecholangiopan creatography,MRCP)是利用磁共振水成像技术,即重T2加权使含水的胆胰管显影,从而确定胆道梗阻的部位和程度,不仅具有无创伤、不需要造影剂、简便易行等优点,而且能显示完整的胆胰管系统,所以具有很高的敏感性、特异性和准确性,     

The clinicopathologic features of intraductal papillary mucinous neoplasms of the pancreas

Since first described in 1982, intraductal papillary mucinous neoplasm (IPMN) has been the preferred term to describe the proliferation of the pancreatic ductal epithelium. It is totally different from pancreatic carcinoma in epidemiology, histology, pathology and prognosis. According to the site of involvement, IPMNs are classified into three categories, i.e. main duct type, branch duct type, and combined type. Most branch duct IPMNs are benign, whereas the other two types are often malignant. A large branch duct IPMN and marked dilation of the main pancreatic duct indicate the presence of adenoma at least. The additional existence of large mural nodules increases the possibility of malignancy in all types. The prognosis is more favorable after complete resection of benign and non-invasive malignant IPMNs. Malignant IPMNs that become more aggressive after parenchymal invasion necessitate adequate lymph node dissection. On the other hand, asymptomatic branch duct IPMNs without mural nodules can be observed without the need for resection for a considerable period of time. Our review addresses available data, current understanding, controversy, and future directions about IPMNs.     

MSCT、MRI观察胰腺囊性肿瘤血供情况及病理形态的临床价值

目的 对比多层螺旋CT(MSCT)、核磁共振(MRI)在胰腺囊性肿瘤血供及病理形态诊断中的应用价值.方法 回顾性分析经临床病理证实为胰腺囊性肿瘤患者49例的临床资料,均行MSCT和MRI扫描,对比扫描结果.结果 MRI诊断胰腺囊性肿瘤的准确率为89.80％显著高于MSCT的73.47％,MRI诊断IPMN的准确性为100.0％,显著高于MSCT的80.0％,差异有统计学意义(P＜0.05).MSCT对钙化的检出率高于MRI,对中心瘢痕、壁结节或实性成分、囊性成分、与胰腺管相通的检查情况低于MRI,差异有统计学意义(P＜0.05).结论 MSCT与MRI均能够显示胰腺囊性肿瘤的形态和血供情况,但MRI诊断胰腺囊性肿瘤可获得更加丰富的信息.     

An analysis of clinico-pathologic features of intraductal papillary mucinous neoplasm of the pancreas

The natural history and clinical manifestation of resected intraductal papillary mucinous neoplasm (IPMN) of the pancreas were elucidated, and based on this, a retrospective pancreatic database was reviewed to identify patients with IPMN who were surgically managed in our department from 1999 to June 2006. Pathologic rereview of each case was performed, and the clinico-pathologic features were examined. Student’s T test and χ² analysis were used to identify factors associated with malignancy. Fifty-one patients were identified. There were 33 males and 18 females. One patient’s pancreas was unresectable, two patients underwent a total pancreatectomy, 42 patients had a pancreatecoduodenectomy and five patients had distal pancreatectomy. Main-duct type carcinoma was identified in 24 patients; branch-duct type in 15 patients, and mixed type in 12 patients. Invasive carcinoma was present in 35 patients. Weight loss and jaundice occurred more commonly in the invasive group. The average serum CA19-9 level was significantly higher in the invasive group (1542μ vs 94.5μ). The average diameter of the pancreatic duct was also wider in the invasive group (8.7 mm vs 4.3 mm). Significant predictors of malignant IPMNs included weight loss, jaundice, a high level of serum CA19-9, a large pancreatic duct and main-duct type carcinoma.     

Spontaneous Neoplasms in Control Wistar Rats: A Comparison of Reviews

Spontaneous neoplasms in 930 control Wistar rats from five carcinogenicitybioassays conducted between 1990 and 1995 were reviewed andcompared with review findings in studies between 1980 and 1990.Mean survival at 104 weeks was 55% for males and 60% for females,similar to that of the previous review. A total of 1599 neoplasmswas diagnosed in 361 (78%) male and 415 (89%) female rats; 1293(81%) of these were benign and 306 (19%) were malignant (11%with metastases). Sixty-eight percent of all neoplasms werein endocrine and integumentary systems, similar to 74% seenin the previous review. Most common neoplasms (affecting >7%of either sex) were pituitary adenoma (34% of males, 50% offemales), benign adrenal pheochromocytoma (10% of males, 1%of females), thyroid C cell adenoma (6% of males, 8% of females),mammary fibroadenoma (3% of males, 36% of females), keratoacanthoma(11% of males, 0.6% of females), testicular interstitial celltumor (11% of males), uterine stromal polyp (16% of females),pancreatic acinar cell adenoma (13% of males, 0.6% of females),and benign thymoma (3% of males, 8% of females). Seventeen neoplasmsaffecting 2 to 6.9% of either sex included adrenal corticaladenoma, thyroid follicular adenoma, pancreatic islet cell adenoma,pituitary carcinoma, mammary adenoma, mammary adenocarcinoma,fibroma, fibrosarcoma, dermal papilloma, uterine schwannoma,uterine granular cell tumor, pancreatic acinar cell carcinoma,hepatocellular adenoma, lymphoma, granular cell meningioma,renal mesenchymal tumor, and hemangiosarcoma. Remaining neoplasmsoccurred in fewer than 2% of animals. Mean tumor incidence didnot differ significantly between our two reviews. Ratios ofbenign to malignant neoplasms were similar in both reviews andpercentages of survival at 104 weeks were similar. Between thetwo reviews, greater than threefold increase in frequency ofsome neoplasms occurred only in males and included keratoacanthomas,pancreatic acinar cell adenomas/carcinomas, and astrocytomas.Frequencies of remaining neoplasms were within twofold or within10% of previous frequencies. Some neoplasms diagnosed in thisreview but not in the previous review included cardiac schwannoma,pilomatrixoma, parathyroid adenoma, and prostatic adenoma butincidence was approximately 1% any one tumor. Based on thesereviews, Wistar rats appear to have a predilection to pituitaryneoplasms and mammary fibroadenomas (females).     

Morphologic, biologic and biochemical characteristics of three human pancreatic ductal adenocarcinomas established as xenotransplants in the nude mouse

Three new human pancreatic adenocarcinomas of ductal origin, covering the spectrum of well differentiated to poorly differentiated neoplasms, have been established as xenotransplants in the nude mouse. Histopathological and ultrastructural features confirmed the neoplasms' ductal origin and were consistently reproduced through serial transplant generations. Carcinoembryonic antigen was only elaborated by the well differentiated neoplasms and production of lactate dehydrogenase isoenzymes was characteristic of each tumor. The morphological and biological features of these tumors make them a valuable addition to the very small number of available pancreatic tumor lines in studies aiming at clarifying many aspects of the biology of this type of neoplasia.     

Spontaneous Neoplasms in Control Wistar Rats

Neoplastic data on 1370 control Wistar rats from 10 carcinogenicitybioassays done between 1980 and 1990 were reviewed. Mean percentagesurvival at 104 weeks was 58% for males and 59% for females.A total of 1857 neoplasms were diagnosed in 466 (68%) male and582 (85%) female rats; 1390 were benign and 467 were malignant(12% with metastasis). Seventy-four percent of all neoplasmswere in endocrine and reproductive systems. Most common neoplasms(affecting more than 7% of either sex) were pituitary adenoma(27.7% males; 55.0% females), mammary fibroadenoma (1.0% males;25.3% females), mammary adenocarcinoma (1.0% males; 13.1% females),adrenal cortical adenoma (8.3% males; 9.3% females), and endometrial stromal polyp (9.6% females). Fourteen neoplasms affecting2 to 6% of either sex included adrenal pheochromocytoma, thyroidC cell adenoma, thyroid follicular adenoma, pancreatic isletcell adenoma, lymphoma, histiocytic sarcoma, thymoma, hepaticadenoma, pancreatic acinar adenoma, mammary adenoma, dermalfibroma, astrocytoma, testicular interstitial cell tumor, andovarian granulosa cell tumor. Remaining neoplasms were seenin less than 2% of animals.     

Novel thiosemicarbazone iron chelators induce up-regulation and phosphorylation of the metastasis suppressor N-myc down-stream regulated gene 1: a new strategy for the treatment of pancreatic cancer

Pancreatic cancer is an aggressive neoplasm, with a mortality rate close to 100%. The most successful agent for pancreatic cancer treatment is gemcitabine, although the overall effect in terms of patient survival remains very poor. This study was initiated to evaluate a novel class of anticancer agents against pancreatic cancer. This group of compounds belongs to the dipyridyl thiosemicarbazone class that have been shown to have potent and selective activity against a range of different neoplasms in vitro and in vivo. We demonstrate for the first time in pancreatic cancer that these agents increase the expression of the growth and metastasis suppressor N-myc downstream-regulated gene 1 and its phosphorylation at Ser330 and Thr346 that is important for its activity against this tumor. In addition, these agents increased expression of the cyclin-dependent kinase inhibitor p21(CIP1/WAF1), whereas decreasing cyclin D1 in pancreatic cancer cells. Together, these molecular alterations account, in part, for the pronounced antitumor activity observed. Indeed, these agents had significantly higher antiproliferative activity in vitro than the established treatments for pancreatic cancer, namely gemcitabine and 5-fluorouracil. Studies in vivo demonstrated that a novel thiosemicarbazone, namely di-2-pyridylketone 4-cyclohexyl-4-methyl-3-thiosemicarbazone hydrochloride, completely inhibited the growth of pancreatic cancer xenografts with no evidence of marked alterations in normal tissue histology. Together, our studies have identified molecular effectors of a novel and potent antitumor agent that could be useful for pancreatic cancer treatment.     

Current approaches to novel therapeutics in pancreatic cancer

Pancreatic cancer is one of the most refractory neoplasms to medical treatment. Until now there has been only modest improvement in the treatment of this disease. Standards of care for combined-modality treatment of resectable as well as locally advanced, unresectable disease have not been uniformly accepted to date because of an equivocal or conflicting data. The inception of gemcitabine introduced the new era in the management of metastatic pancreatic cancer, however, new therapeutic approaches still need to be defined. The article discusses the current knowledge of the biology of this lethal disease, its impact on treatment options, and explores novel therapeutic modalities that are likely to improve outcomes and survival for patients in the future.     

Spontaneous neoplasms in aged sprague-dawley rats

Incidence of neoplastic lesions in untreated Sprague-Dawley rats (1340 males and 1329 females) used as controls in 17 carcinogenicity studies are tabulated and evaluated. In male rats, the most common neoplasms were benign pheochromocytomas and keratoacanthomas (4.0% in each case) followed by pancreatic islet cell adenomas (3.7%), thyroid parafollicular cell adenomas (3.6%), fibromas and squamous cell papillomas of the skin and hepatocellular adenomas (2.0% in each), malignant lymphoma lymphocytic (1.9%), histiocytic sarcomas (1.4%), and adrenal cortical adenomas (1.2%). In female rats, the most common neoplasms were of mammary gland origin (31.3%: fibroadenoma 19.0%, adenocarcinomas 8.8%, and adenomas 3.5%) followed by thyroid parafollicular cell adenomas (2.9%), uterine endometrial stromal polyps (2.6%), adrenal cortical adenomas (1.9%), malignant lymphoma lymphocytic (1.6%), fibromas in the skin (1.3%), and pancreatic islet cell adenoma (1.1%). Metastases were observed from pheochromocytomas, hepatocellular carcinomas, nephroblastomas, renal pelvis transitional cell carcinoma, interstitial cell tumor and seminoma of the testes, Zymbal's gland adenocarcinomas, and mammary adenocarcinomas.     

睾丸肿瘤的超声诊断

目的 总结睾丸肿瘤的声像图特征.方法 回顾分析经病理证实的96例睾丸肿瘤患者的超声表现.结果 96例睾丸肿瘤均表现为低回声肿块.肿瘤声像图与不同病理类型相对应.良性睾丸肿瘤内部血流信号稀少甚至无血流,恶性单丸肿瘤内部及周隔血流信号丰富.结论 超声检查是在睾丸肿瘤诊断和良恶性鉴别诊断中具有非常重要价值的影像学方法.