Abe Hideki, Kimura Wataru, Mori Masaya, Makuuchi Masatoshi, Yanagisawam Akio
Hepatobiliarypancreatic Division, Department of Surgery, University of Tokyo, Tokyo, Japan.
Pancreas. 2005 Jul;31(1):98-100. doi: 10.1097/01.mpa.0000164452.69265.5b.
We report a case of serous cystadenoma of the pancreas mixed with mucinous cystadenoma. A 65-year-old woman was admitted to our hospital for evaluation of a palpable, elastic, hard mass measuring 6 cm in diameter in the right upper quadrant of the abdomen. A diagnosis of mucinous cystadenocarcinoma of the pancreas was made, and pancreatoduodenectomy was performed. The tumor was composed of a dominant compartment of macroscopic cyst, and its thick wall was filled with numerous microscopic cysts. The light microscopy findings with hematoxylin and eosin staining, and by the periodic acid-Schiff reaction, were almost perfectly consistent with the characteristics of microcystic or glycogen-rich cystadenoma, but the apical portion of the cytoplasm of the neoplastic cells was stained with Alcian blue at pH 2.4 and by the mucicarmine method. Neoplastic cells containing epithelial acidic mucin are usually found in mucinous cystadenomas. No K-ras point mutations were detected at the sites where neoplastic cells were present, whether or not they contained epithelial acidic mucin. Pancreatic serous cystadenomas that include a mucinous-cystadenoma component are extremely rare, and the difference between serous and mucinous cystadenomas is not always distinct.
我们报告一例胰腺浆液性囊腺瘤合并黏液性囊腺瘤的病例。一名65岁女性因腹部右上象限可触及一个直径6厘米的可触及的、有弹性的硬块而入院接受评估。诊断为胰腺黏液性囊腺癌，并进行了胰十二指肠切除术。肿瘤由一个占主导的宏观囊肿腔组成，其厚壁充满了无数微小囊肿。苏木精和伊红染色以及过碘酸希夫反应的光镜检查结果几乎与微囊性或富含糖原的囊腺瘤的特征完全一致，但肿瘤细胞的细胞质顶端部分在pH 2.4时用阿尔辛蓝染色，并用黏液卡红法染色。含有上皮酸性黏蛋白的肿瘤细胞通常见于黏液性囊腺瘤。在存在肿瘤细胞的部位，无论是否含有上皮酸性黏蛋白，均未检测到K-ras点突变。包含黏液性囊腺瘤成分的胰腺浆液性囊腺瘤极为罕见，浆液性和黏液性囊腺瘤之间的差异并不总是很明显。
