Jani N, Dewitt J, Eloubeidi M, Varadarajulu S, Appalaneni V, Hoffman B, Brugge W, Lee K, Khalid A, McGrath K
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Endoscopy. 2008 Mar;40(3):200-3. doi: 10.1055/s-2007-995364. Epub 2007 Dec 7.
Solid pseudopapillary tumors of the pancreas are rare, low-grade, epithelial neoplasms that are usually discovered incidentally in young women. Distinguishing solid pseudopapillary tumors from other pancreatic tumors, especially pancreatic endocrine tumors, can be challenging. The role of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in this context remains unclear. The purpose of this study was to describe the endoscopic ultrasound features of solid pseudopapillary tumors and the role of EUS-FNA in the preoperative diagnosis of these tumors.
Patients from five tertiary referral centers with surgically confirmed solid pseudopapillary tumors who had undergone preoperative EUS-FNA were included. The endoscopic ultrasound findings, cytologic descriptions, immunostaining results, operative records, surgical pathology, and results of the most recent clinical follow-up were reviewed.
A total of 28 patients were identified (four men [14 %], 24 women [86 %], mean age +/- standard deviation [SD] 35 +/- 10 years). Solid pseudopapillary tumors had been found as incidental findings on cross-sectional imaging in 50 % of cases. The mean tumor size +/- SD was 42 +/- 19.5 mm and the majority were located in the pancreatic body and tail. The endoscopic ultrasound report described a well-defined, echo-poor mass in 86 %; the tumors were solid in 14 patients (50 %), mixed solid and cystic in 11 patients (39 %), and cystic in three patients (11 %). A preoperative diagnosis of solid pseudopapillary tumor was made in 21 patients (75 %) on the basis of EUS-FNA cytology. Surgical resection was performed in all cases. Laparoscopic resection was performed in eight of these patients (29 %).
A solid pseudopapillary tumor should be included in the differential diagnosis of any well-demarcated, echo-poor, solid or mixed solid/cystic pancreatic lesion seen during endoscopic ultrasound, particularly in young women. The diagnostic accuracy of EUS-FNA for solid pseudopapillary tumors was 75 % in this study. A definitive preoperative diagnosis can guide the surgical approach in selected cases.
胰腺实性假乳头状瘤是一种罕见的、低级别上皮性肿瘤，通常在年轻女性中偶然发现。将实性假乳头状瘤与其他胰腺肿瘤，尤其是胰腺内分泌肿瘤区分开来可能具有挑战性。在这种情况下，内镜超声引导下细针穿刺活检（EUS-FNA）的作用仍不明确。本研究的目的是描述实性假乳头状瘤的内镜超声特征以及EUS-FNA在这些肿瘤术前诊断中的作用。
纳入来自5个三级转诊中心、经手术证实为实性假乳头状瘤且术前行EUS-FNA的患者。回顾了内镜超声检查结果、细胞学描述、免疫染色结果、手术记录、手术病理以及最近的临床随访结果。
共确定28例患者（4例男性[14%]，24例女性[86%]，平均年龄±标准差[SD]为35±10岁）。50%的病例中实性假乳头状瘤是在横断面成像时偶然发现的。肿瘤平均大小±SD为42±19.5mm，大多数位于胰体和胰尾。内镜超声报告显示86%的肿瘤边界清晰、回声低；14例患者（50%）的肿瘤为实性，11例患者（39%）为实性和囊性混合，3例患者（11%）为囊性。21例患者（75%）根据EUS-FNA细胞学检查术前诊断为实性假乳头状瘤。所有病例均行手术切除。其中8例患者（29%）行腹腔镜切除。
对于内镜超声检查中发现的任何边界清晰、回声低的实性或实性/囊性混合胰腺病变，尤其是年轻女性，鉴别诊断时应考虑实性假乳头状瘤。本研究中EUS-FNA对实性假乳头状瘤的诊断准确率为75%。明确的术前诊断可指导部分病例的手术方式选择。
