中华病理学杂志
中華病理學雜誌
중화병이학잡지
Chinese Journal of Pathology
2013年
4期
248-251
,共4页
常晓燕%卢朝辉%李星奇%陈杰
常曉燕%盧朝輝%李星奇%陳傑
상효연%로조휘%리성기%진걸
胰腺肿瘤%DNA突变分析%诊断
胰腺腫瘤%DNA突變分析%診斷
이선종류%DNA돌변분석%진단
Pancreatic neoplasms%DNA mutational analysis%Diagnosis
目的 探讨胰腺导管内管状乳头状肿瘤的临床病理学特征、诊断、鉴别诊断及分子生物学特点.方法 收集北京协和医院病理科2001年1月至2010年6月间6例胰腺导管内管状乳头状肿瘤病例,分析其临床特点,对标本进行病理形态学观察、免疫组织化学EnVision法和RT-PCR方法检测KRAS基因突变.结果 6例导管内管状乳头状肿瘤有男2例,女4例,平均年龄64岁.大体检查胰腺大导管内可见息肉样结节阻塞导管,1例扩张的导管周围可见质硬结节.镜下观察,导管内可见小管状腺体或小的腺泡样腺体背靠背密集排列,上皮细胞重度异型增生,核分裂象多见,细胞内几乎没有黏液,导管内的小灶坏死较常见.1例病变完全局限在导管内,4例局部可见微小浸润(＜0.5 cm),1例浸润深度＞1 cm;浸润成分为导管腺癌.免疫组织化学显示CK7和CK19均阳性,MUC5AC有3例阴性,3例局灶弱阳性；MUC2阴性；MUC1有2例局灶阳性；Ki-67阳性指数高.KRAS基因检测2/6阳性,突变位点分别为35G＞A及35G＞ T/34G＞A.6例随访12～ 112个月,平均随访时间为37个月,1例19个月后死于该肿瘤,1例胰尾手术83个月后胰头复发,余4例无复发及转移.结论 胰腺导管内管状乳头状肿瘤具有导管内腺管状和乳头状生长方式,上皮重度异型增生,细胞内外黏液分泌少等特点,在生长方式、黏液分泌及免疫组织化学表达等方面与导管内乳头状黏液性肿瘤有不同之处；与导管内乳头状黏液性肿瘤分开的意义尚需更多病例验证.
目的 探討胰腺導管內管狀乳頭狀腫瘤的臨床病理學特徵、診斷、鑒彆診斷及分子生物學特點.方法 收集北京協和醫院病理科2001年1月至2010年6月間6例胰腺導管內管狀乳頭狀腫瘤病例,分析其臨床特點,對標本進行病理形態學觀察、免疫組織化學EnVision法和RT-PCR方法檢測KRAS基因突變.結果 6例導管內管狀乳頭狀腫瘤有男2例,女4例,平均年齡64歲.大體檢查胰腺大導管內可見息肉樣結節阻塞導管,1例擴張的導管週圍可見質硬結節.鏡下觀察,導管內可見小管狀腺體或小的腺泡樣腺體揹靠揹密集排列,上皮細胞重度異型增生,覈分裂象多見,細胞內幾乎沒有黏液,導管內的小竈壞死較常見.1例病變完全跼限在導管內,4例跼部可見微小浸潤(＜0.5 cm),1例浸潤深度＞1 cm;浸潤成分為導管腺癌.免疫組織化學顯示CK7和CK19均暘性,MUC5AC有3例陰性,3例跼竈弱暘性；MUC2陰性；MUC1有2例跼竈暘性；Ki-67暘性指數高.KRAS基因檢測2/6暘性,突變位點分彆為35G＞A及35G＞ T/34G＞A.6例隨訪12～ 112箇月,平均隨訪時間為37箇月,1例19箇月後死于該腫瘤,1例胰尾手術83箇月後胰頭複髮,餘4例無複髮及轉移.結論 胰腺導管內管狀乳頭狀腫瘤具有導管內腺管狀和乳頭狀生長方式,上皮重度異型增生,細胞內外黏液分泌少等特點,在生長方式、黏液分泌及免疫組織化學錶達等方麵與導管內乳頭狀黏液性腫瘤有不同之處；與導管內乳頭狀黏液性腫瘤分開的意義尚需更多病例驗證.
목적 탐토이선도관내관상유두상종류적림상병이학특정、진단、감별진단급분자생물학특점.방법 수집북경협화의원병이과2001년1월지2010년6월간6례이선도관내관상유두상종류병례,분석기림상특점,대표본진행병리형태학관찰、면역조직화학EnVision법화RT-PCR방법검측KRAS기인돌변.결과 6례도관내관상유두상종류유남2례,녀4례,평균년령64세.대체검사이선대도관내가견식육양결절조새도관,1례확장적도관주위가견질경결절.경하관찰,도관내가견소관상선체혹소적선포양선체배고배밀집배렬,상피세포중도이형증생,핵분렬상다견,세포내궤호몰유점액,도관내적소조배사교상견.1례병변완전국한재도관내,4례국부가견미소침윤(＜0.5 cm),1례침윤심도＞1 cm;침윤성분위도관선암.면역조직화학현시CK7화CK19균양성,MUC5AC유3례음성,3례국조약양성；MUC2음성；MUC1유2례국조양성；Ki-67양성지수고.KRAS기인검측2/6양성,돌변위점분별위35G＞A급35G＞ T/34G＞A.6례수방12～ 112개월,평균수방시간위37개월,1례19개월후사우해종류,1례이미수술83개월후이두복발,여4례무복발급전이.결론 이선도관내관상유두상종류구유도관내선관상화유두상생장방식,상피중도이형증생,세포내외점액분비소등특점,재생장방식、점액분비급면역조직화학표체등방면여도관내유두상점액성종류유불동지처；여도관내유두상점액성종류분개적의의상수경다병례험증.
Objective To study the pathologic features,diagnosis,differential diagnosis and molecular characteristics of intraductal tubulopapillary neoplasm of the pancreas (ITPN).Methods The clinical findings,morphologic features,immunophenotype (by EnVision method) and KRAS gene alterations (by reverse transcriptase-polymerase chain reaction) of 6 cases of ITPN encountered during the period from January,2001 to June,2010 were analyzed.Results There were altogether 2 males and 4 females.The mean age of the patients was 64 years.Gross examination showed that the tumors were located in large pancreatic ducts and appeared as polypoid nodules with ductal obstruction.Solid tumor nodules associated with adjoining dilated ducts were identified in one case.Histologically,the tumors were characterized by tubulopapillary growth pattern without luminal mucin.The tumor cells showed high-grade nuclear atypia with scanty intracytoplasmic mucin.Intraductal necrotic foci were frequently observed.Immunohistochemical study showed that the tumor cells expressed CK7 and CK19.Focal positivity for MUC5AC was demonstrated.Two cases expressed MUC1.The staining for MUC2 was negative.KRAS gene mutations were identified in 2 cases,with a single-amino-acid substitution in codon 12 (35G ＞ A and 35G ＞ T/34G ＞ A).Conclusions ITPN is a newly described pancreatic intraductal neoplasm and different from intraductal papillary mucinous neoplasm.ITPN is characterized by intraductal tubulopapillary growth pattern,severe cytologic atypia and scanty mucin secretion.
