Burkadze George, Turashvili Gulisa
Department of Pathology, N. Kipshidze Central University Clinic, Vazha-Pshavela Avenue, 0160, Tbilisi, Georgia.
Pathol Oncol Res. 2009 Mar;15(1):129-31. doi: 10.1007/s12253-008-9053-9. Epub 2008 May 21.
A 34-year-old, previously healthy female presented with severe acute upper quadrant abdominal pain and an 11-cm cystic mass in the tail of the pancreas. The patient underwent distal pancreatectomy with total gross excision of the mass. Grossly, the mass consisted of a multiloculated cystic lesion measuring 11.7 cm in its greatest dimension. An irregular solid lobulation at the lateral aspect of the cyst was visible, measuring 3 cm in the largest dimension. Histologically, there were two distinct components: a mucinous, neoplastic epithelial cyst with few foci of moderate atypia, and nodular spindle cell areas containing multinucleated tumor giant cells. Immunohistochemically, the multinucleated giant cells were positive for vimentin, CD68 and CD45, and negative for cytokeratin and epithelial membrane antigen (EMA). The spindle cells of hypercellular stroma were stained for vimentin, but not for EMA or carcinoembryonic antigen (CEA). Neuron-specific enolase (NSE), S100 and Ki-67 showed no reactivity. The histological diagnosis "osteoclast-like giant cell tumor of the pancreas associated with borderline mucinous cystic neoplasm" was made. The patient recovered and is free of disease 4 years after the diagnosis.
一名34岁、既往健康的女性，出现严重的急性上腹部疼痛，胰腺尾部有一个11厘米的囊性肿块。患者接受了远端胰腺切除术，肿块被完全肉眼切除。大体上，肿块由一个最大直径为11.7厘米的多房囊性病变组成。在囊肿外侧可见一个不规则的实性分叶，最大直径为3厘米。组织学上，有两个不同的成分：一个黏液性、肿瘤性上皮囊肿，有少数中度异型性灶，以及含有多核肿瘤巨细胞的结节状梭形细胞区域。免疫组化显示，多核巨细胞波形蛋白、CD68和CD45呈阳性，细胞角蛋白和上皮膜抗原（EMA）呈阴性。细胞丰富的间质中的梭形细胞波形蛋白染色阳性，但EMA或癌胚抗原（CEA）染色阴性。神经元特异性烯醇化酶（NSE）、S100和Ki-67无反应性。做出了“与交界性黏液性囊性肿瘤相关的胰腺破骨细胞样巨细胞瘤”的组织学诊断。患者康复，诊断后4年无疾病。
