胰腺实性假乳头状瘤7例临床病理特征并文献复习

目的探讨胰腺实性假乳头状瘤（SPTP）的临床病理特征以及免疫组化特点。方法对7例SPTP进行临床、组织病理、免疫表型的观察并复习相关文献。结果 7例SPTP,男女之比为2∶5,平均年龄34岁,仅3例有临床症状。6例发生于胰腺,有1例发生在胰腺外。肿瘤均呈囊实性;组织学上肿瘤细胞形态较一致,呈巢状排列,并形成假乳头状结构,部分瘤细胞呈透明细胞样细胞改变;间质黏液样变性、异物巨细胞反应及胆固醇样结晶。免疫组化结果显示：瘤细胞Vimentin、AAT呈强阳性,EMA均呈阴性;部分病例NSE、Syn、CgA、CD56、CD10、、AE1/AE3、PR局部阳性。4例术后随访30～114个月,患者均未发现复发及转移。结论 SPTP少见,多见于年轻女性,以实性、假乳头结构为主要组织学特征,并伴有其它多种组织学结构及多向分化的免疫组化表型。免疫组织化学检测结果对SPTP诊断具有重要价值,AAT、Vimentin阳性是诊断SPTP的可靠依据。

Clinicopathological Analysis of 6 Case of Solid-pseudopapillary Tumor of Pancreas and Review of Literature

Objective To study the clinicopathological features and immunohistochemical characteristics of solid-pseudopapillary tumor of pancreas（SPTP）.Methods Clinical data,histopathological features and immunotypes of 7 patients with SPTP were observed and literatures were reviewed.Results The ratio of female to male was 5：2 and the average age was 34 years old.Only 3case had symptom.6case occurred in pancreas and 1 case was occurred ultra-pancreas.All the cases were solid-cystic and grossly appeared encapsulated.Histopathologically,the tumor cells were uniform and nest-arranged,with typical pseudopapillary pattern.Some tumor cells exhibited clear-cell-like change.There were mucus degeneration,multinuclear giant cell reaction and clolesterol clefts in the stroma.Immunohistochemical results showed that the tumor cells reacted strongly with vimentin and AAT,while EMA were negative in all case.Some cases were stained locally with NSE,Syn,CgA,CD56,CD10,AE1/AE3,PR.Of the 4 patients with complete follow-up data from 30 to 114 months after operation,no patient had recurrent disease.Conclusion SPTP is an uncommon neoplasm,and is predominantly occurred in young women.The main histological characteristics are solid and pseudopapillary structures of the tumor cells,accompanied with various other histological patterns and multiple immunophenotypes.Immunohistochemical method is important for the diagnosis of SPTP,and postive expression of AAT and vimentin is a reliable evidence for the diagnosis of SPTP.