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- 试传病例
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本帖最后由 于 2006-10-02 10:14:00 编辑
This is probably a case of intraductal papillary mucinous tumor (IPMT) of pancreas (most occurring in men). The gross photo shows seemingly centrally located, fusiform dilatation of main pancreatic duct. Microscopic photos, on the other hand, clearly show papillary growth of mucinous type columnar epithelia. In my opinion, the lining cells do not display definite dysplasia, and the photos do not display stromal invasion. These histologic malignant features have to be carefully sought for on microscopic examination of any cyctic neoplasm of pancreas. The other category of tumor mentioned by Dr. Shih is the mucinous cystic tumors (MCT) of pancreas that occur more frequently in women. Unlike those in the ovaries, histologic and cytologic benignity (bland cytology without stromal invasion) does not always impart a benign clinical behavior. In other words, some histologically and cytologically "benign" mucinous cystic tumors of pancreas metastatize and kill the patients. Interestingly, mucinous cystic tumors of pancreas often often contain focally luteinized "ovarian type" stroma that mimics that found in neoplastic and non-neoplastic ovaries. Furthermore, hCG immunohistochemical staining shows that some of the lining glandular epithelia of these tumors have cytoplasmic immunoreactivity and suggests them as the cause for the observed stromal luteinization. For reference, please visit the following websites:
1. http://www.afip.org/Departments/Endocrine/publications/pancreas.html
2. http://www.joplink.net/prev/200401/news.html
3. http://www.emedicine.com/radio/topic518.htm
4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12684617&dopt=Abstract
聞道有先後,術業有專攻
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mjma大夫讲得很全面了，可能有少数网友英语看的比较吃力，我补充一点中文内容：
WHO把来源于主胰管或其主要分支的肿瘤称为胰腺大导管内乳头状黏液性肿瘤，即IPMN, 根据乳头上皮的异型程度和分泌黏液的量和侵袭性的不同,IPMN又被分为良性,交界性和恶性。发生于大导管的IPMN预后明显好,切除后5年生存率可达65%～85%。
IPMN需要与粘液性囊性肿瘤（MCN）鉴别，二者的主要鉴别点为:IPMN：好发年龄为60～70，男女相近，胰头多见，多有胰腺炎病史，多发或多房，与主胰管相通，发生于主导管或分支导管，CT示囊腔常有间隔，常有钙化，无卵巢样间质，表达MUC2，MUC5AC；而MCN多见于40～60，女性多见，绝大多数位于胰体尾部，单房或多房，与主导管不相通，钙化少见，常有卵巢样间质，CT显示囊腔无间隔，上皮表达MUC5AC+/MUC1 。
- the more we discuss, the more we learn from each other !!
| 以下是引用mjma 在2006-10-2 10:03:00的发言： This is probably a case of intraductal papillary mucinous tumor (IPMT) of pancreas (most occurring in men). The gross photo shows seemingly centrally located, fusiform dilatation of main pancreatic duct. Microscopic photos, on the other hand, clearly show papillary growth of mucinous type columnar epithelia. In my opinion, the lining cells do not display definite dysplasia, and the photos do not display stromal invasion. These histologic malignant features have to be carefully sought for on microscopic examination of any cyctic neoplasm of pancreas. The other category of tumor mentioned by Dr. Shih is the mucinous cystic tumors (MCT) of pancreas that occur more frequently in women. Unlike those in the ovaries, histologic and cytologic benignity (bland cytology without stromal invasion) does not always impart a benign clinical behavior. In other words, some histologically and cytologically "benign" mucinous cystic tumors of pancreas metastatize and kill the patients. Interestingly, mucinous cystic tumors of pancreas often often contain focally luteinized "ovarian type" stroma that mimics that found in neoplastic and non-neoplastic ovaries. Furthermore, hCG immunohistochemical staining shows that some of the lining glandular epithelia of these tumors have cytoplasmic immunoreactivity and suggests them as the cause for the observed stromal luteinization. For reference, please visit the following websites: |
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学习mjma老师的讲解并试译如下：
这可能是一例胰腺导管内乳头状粘液性肿瘤（IPMT，大多数发生于男性。大体照片显示中心位置、融合性扩张的胰腺大导管。镜下照片清楚地显示粘液性柱状上皮的乳头状生长。我的观点，衬覆细胞无明显异型性，照片中也无间质浸润。对于胰腺的任何囊性肿瘤，这些组织学恶性特征必须在镜下仔细寻找。Dr. Shih提到其它分类：胰腺的粘液性囊性肿瘤（MCT）更多发生于女性。不像卵巢所见，组织学和细胞学善良（细胞温和无浸润）并不总是意味着良性临床行为。换言之，一些组织学和细胞学“良性”的胰腺粘液性囊性肿瘤可转移并致命。有趣的是，胰腺粘液性囊性肿瘤通常含有局灶性黄素化的“卵巢型”间质，非常相似于肿瘤性和非肿瘤性卵巢内所见。而且，这些肿瘤hCG染色显示一些衬覆腺上皮有胞浆着色，提示这是所观察到的间质黄素化的原因。参考文献，请访问以下站点：
1. http://www.afip.org/Departments/Endocrine/publications/pancreas.html
2. http://www.joplink.net/prev/200401/news.html
3. http://www.emedicine.com/radio/topic518.htm
4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12684617&dopt=Abstract
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