目的 总结胰腺实性假乳头状瘤（solid-pseudopapillary tumor of pancreas, SPTP）的诊治经验。方法 回顾性分析我院1999年11月至2007年10月期间收治的6例SPTP患者的临床资料。结果 6例均为女性，其中4例为年轻女性； 术前均未确诊； 行胰腺体尾部切除2例，肿瘤局部切除4例，其中2例加脾切除，术后病理报告确诊为SPTP。 术后无严重并发症，随访1～95个月，无复发和转移。结论 SPTP多发于年轻女性，术中冰冻切片对术中处理提供参考，手术切除为首选治疗方法，预后良好。
ObjectiveTo investigate the imaging features of insulinoma on multi-slice spiral CT (MSCT) and magnetic resonance imaging (MRI) with correlation of pathology. MethodsAll images of 8 patients confirmed by surgery and pathology were retrospectively analyzed with correlation of pathology. MSCT scans were performed in 4 patients and MR scans in 6 patients, among which 2 patients accepted both MSCT and MRI examinations. ResultsInsulinoma in all patients manifested as solitary lesions with diameters of 0.5-3.5 cm. Four lesions demonstrated isodensity or hypodensity on plain MSCT, with significant enhancement on arterial phase, and relative isodensity or slight hyperdensity on portal phase and delay phase. On plain MRI, lesions demonstrated hyperintensity on T1WI, slight hyperintensity or hyperintensity on T2WI. The enhanced patterns of insulinoma were similar to the findings on MSCT. ConclusionsThe imaging characteristics of insulinoma reflect the pathological features. MSCT and MRI are effective in the diagnosis of inslinoma, and MRI can show more diagnostic information.
Objective To investigate the clinicopathologic features and effect of surgical treatment of pancreatic neuroendocrine carcinoma（PNEC）. Methods Clinical data of 31 patients with PNEC treated from Jan. 2008 to Mar. 2012 in our hospital were analyzed，and the expressions of protein CgA，Syn，CD56，CK，VEGF，and Ki-67 were detected by immunohistochemical method. The differences of survival rate and time between radical excision group and palliative surgery group were analyzed by log-rank test. Results Of the 31 patients，22 patients received radical resection and 9 patients received palliative surgery. The positive expression rate of protein CgA，Syn，CD56，CK，and VEGF was 64.52%（20/31），100%（31/31），77.42%（24/31），90.32%（28/31），90.32%（28/31），respectively. According to the percentage of Ki-67 positive cells， 14（45.16%） patients expressed less than 3%，7（22.58%） patients expressed between 3% and 20%， and 10（32.26%）patients expressed more than 20%. The survival rate and time of radical resection group were significantly higher and longer than palliative surgery group（P＜0.001）. Conclusions PNEC is a high potential malignancy and demonstrates aggressive biological behavior. Radical resection can improve the prognosis of patients with PNEC.
目的 探讨胰腺良性微小肿瘤的术前及术中定位方法。方法 对1995年1月至2000年8月收治的12例直径lt;2 cm的胰腺良性肿瘤定位方法进行分析。结果 术前B超、CT或MRI和动脉造影的诊断敏感性分别是16.7%、40.0%和87.5%。通过术中探查发现病灶7例（58.3%），其余5例借助于术中B超定位成功4例。结论 术中B超是目前最有价值的定位手段，而且还能提供病灶更详细的资料，对顺利完成手术、减少并发症有重要作用。在定位过程中注意操作细节可提高定位诊断的成功率。
ObjectiveTo study the clinicopathologic features, diagnosis and treatment of papillary cystic and solid tumor of the pancreas (PCSTP).MethodsOne case with PCSTP in our hospital and a review of 60 others from the literatures of the People’s Republic of China, a total of 61 cases were analyzed retrospectively.ResultsThe patients (57 women, 4 men) were of mean age 24.6 (range 9~59) years. The main manifestations included abdominal mass (n=52), pain (n=22) and discomfort (n=10). They were distributed in the head (n=29), neck and body (n=2), body (n=1), body and tail (n=5), tail (n=16) and capsule (n=2) of the pancreas. The other 6 cases occurred outside the pancreas. All the patients underwent surgical therapy. The tumors were identified by postoperative histopathologic examination, 7 of which were malignant (11.5%). The total 1, 3, 5year survival rate was 100%, 96.1% and 86.5% respectively.ConclusionIt is difficult to correctly diagnose the PCSTP before operation because PCSTP is often lack of typical clinical manifestations. The correct diagnosis should depend on histopathologic examination.Complete removal of the PCSTP is the most perfect treatment. PCSTP has a good prognosis.
Objective To know the abnormal expression of the cell cycle-regulated proteins in pancreatic adenocarcinoma and their effect on tumor cell growth. Methods The expression of p16, p21, Rb and p53 protein in 47 cases were investigated by immunohistochemistry with wet autoclave pretreatment for antigen retriaval. Furthermore, tumor growth index were assessed by a novel anti-ki-67 antibody (ki-s5). Results All the expression of p53, p16, p21 and Rb protein were the nuclear stainning. The positive rates of p53, p16, p21 and Rb protein were 55%, 53%, 74% and 98% respectively. There was negative correlation between of p16, p21 or Rb protein expression and ki-67 growth index. No relation of p53 protein stainning and the expression of p21 protein was found. Conclusion In pancreatic adenocarcinoma, the negative expression of p16 protein and p21 protein may play an important role in tumor cell growth, but tumor proliferation caused by abnormality of Rb protein is rare. The expression of p21 protein was not associated with the expression of p53 protein.
Objective To provide experimental evidence for the clinical application of ischemia therapy to treating pancreatic cancer. Methods After the model of pancreatic transplanted cancer was established in nude mice with orthotransplantation of human pancreatic cancer cell line into the pancreas, the ischemia of the right lobe of the pancreas was induced with ligation of the gastroduodenal, inferior pancreaticoduodenal and dorsal pancreatic arteries. Effects of regional ischemia on the growth of transplanted cancer and the pathomorphology of the transplanted cancer and pericancerous tissue were investigated. Results The transplanted cancer grew slower and its doubling time was longer in the ischemic group than in the control. On the 3rd, 7th and 14th day after operation, the size of transplanted cancer, the proliferative index and protein content of the cancer cells were significantly lower in the ischemic group than in the control (Ｐ＜0.01). Optical microscopy revealed large areas of coagulation necrosis, necrobiotic cells and the infiltration of inflammatory cells. The atrophy of acini, fibrosis and the infiltration of lymphocyte cells were found in pericancerous tissue. Conclusion Regional ischemia can destroy and inhibit the pancreatic transplanted cancer in nude mice effectively. The ischemia changes of pericancerous tissue may be unfavourable for the growth of the pancreatic transplanted cancer.
ObjectiveTo comparatively analyze the image features of tumorous acute pancreatitis (T-AP) and non-tumorous acute pancreatitis (NT-AP). MethodsSixteen cases of histopathologically proven pancreatic tumors inducing acute pancreatitis and 30 cases of non-tumorous acute pancreatitis were collected, and studied their CT and MRI features. ResultsThere were 16 cases (100%) with focal nodules or masses in T-AP group and none in NT-AP group. The average innerdiameter of main pancreatic ducts in T-AP group was (9.6±6.8) mm, in which 14 cases (87.5%) were dilated. And the average innerdiameter of main pancreatic ducts in NT-AP group was (2.9±0.9) mm, in which 7 cases (23.3%) were dilated. The cases of sinistral portal hypertension (SPH), accompanying cholelithiasis and lymphadenosis between the two groups were 10 (62.5%), 3 (18.8%), 14 (87.5%), and 1 (3.4%), 25 (83.3%), 30 (100%), respectively. The occurrence of manifestation of focal nodules or masses, dilated main pancreatic ducts, SPH, and accompanying cholelithiasis were significantly different (P=0.000) between T-AP and NT-AP groups. While, the differences in enhancement pattern and the occurrence of lymphadenosis between the two groups were not significant (P > 0.05). ConclusionThe image features of T-AP are various. The application of CT and MRI could provide effective diagnostic guidelines for patients with T-AP.
ObjectiveTo summarize the related researches of pancreatic portal hypertension (PPH) in recent years in order to diagnose and treat the disease more timely and effectively. MethodThe literatures relevant to etiology, mechanism, clinical features, diagnostic criteria, and treatment of PPH were searched and reviewed. ResultsThe occurrence of PPH was related to its anatomical structure. Its clinical manifestations were not characteristic, but it was not difficult to diagnose by the assistance of auxiliary examinations. The treatment of PPH was mainly targeted at pancreatic diseases and portal hypertension, and the treatment targeted at portal hypertension was performed according to the situation with or without gastrointestinal bleeding. So, in clinical practice, different treatment measures should be taken according to different situations. ConclusionAt present, the clinical diagnosis and treatment of PPH is relatively mature, but its preventive treatment is still controversial, which will be the focus of future research.