Stelow Edward B, Stanley Michael W, Bardales Ricardo H, Mallery Shawn, Lai Rebecca, Linzie Bradley M, Pambuccian Stefan E
Departments of Pathology and Laboratory Medicine, University of Minnesota, Minneapolis, USA.
Am J Clin Pathol. 2003 Sep;120(3):398-404. doi: 10.1309/CEPK-542W-3885-2LP8.
All clinically and ultrasonographically suspected examples of intraductal papillary-mucinous neoplasm (IPMN) aspirated during a 17-month period were reviewed and analyzed for follow-up. We identified 18 cases of suspected IPMN in patients 52 to 87 years old. All patients had dilated pancreatic ducts, with 3 showing sonographically apparent intraductal papillary lesions; 5 had adjacent cystic or solid pancreatic masses. Cytologic preparations showed thick, glistening, viscid, abnormal mucus in all cases. Aspirates from 13 lesions (72%) were acellular or sparsely cellular, but entrapped single or loosely cohesive neoplastic cells were identified in 16 cases (89%). Goblet cell morphologic features were common (6/18 [33%]), but papillary clusters and dysplastic changes were infrequent (3 [17%] each). In keeping with current therapeutic thinking, confirmatory histologic follow-up was available for only 4 patients (22%), as most people with lesions clinically, sonographically, and cytologically consistent with IPMN are elderly and often have comorbid conditions. Although endoscopic ultrasound-guided fine-needle aspiration has important limitations, gross and cytologic findings can aid in confirming the suspected diagnosis, and integration of complete clinical, sonographic, and cytologic information may be the best way to reach the most accurate diagnosis possible.
对在17个月期间内所有临床及超声检查怀疑为导管内乳头状黏液性肿瘤（IPMN）的病例进行回顾性分析以随访观察。我们共识别出18例年龄在52至87岁之间的疑似IPMN患者。所有患者均有胰腺导管扩张，其中3例超声检查显示导管内有明显的乳头状病变；5例有相邻的胰腺囊性或实性肿块。所有病例的细胞涂片均显示有浓稠、发亮、黏滞的异常黏液。13个病变（72%）的吸出物无细胞或细胞稀少，但16例（89%）中发现有单个或松散聚集的肿瘤细胞。杯状细胞形态特征常见（6/18 [33%]），但乳头状簇和发育异常改变少见（各3例 [17%]）。按照当前的治疗思路，仅有4例患者（22%）获得了组织学随访结果以确诊，因为大多数临床、超声及细胞学表现符合IPMN的患者年龄较大且常伴有合并症。尽管超声内镜引导下细针穿刺活检有重要局限性，但大体及细胞学检查结果有助于确诊可疑诊断，整合完整的临床、超声及细胞学信息可能是获得最准确诊断的最佳方法。
