Huo Zhen, Yang Di, Chang Xiao-Yan, Wan Jian-Wei, Chen Jie
Department of Pathology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China.
Zhonghua Bing Li Xue Za Zhi. 2008 Oct;37(10):670-5.
To study the clinicopathologic features and diagnosis of intraductal papillary mucinous neoplasm (IPMN) of the pancreas.
Nineteen cases of IPMN encountered during the period from 1999 to 2007 were studied by light microscopy and immunohistochemistry.
IPMN occurred more often in males (68%). It affected patients in older age group (mean age = 59) and was located mainly in the head of pancreas (60%). The mean tumor size was 4.2 cm (range = 1 to 8 cm). The clinical presentation was epigastric pain (53%), weight loss (32%), diabetes (21%), pancreatitis (21%) and jaundice (10%). Pancreatectomy was performed in 18 cases. The remaining patient received bypass surgery only. Features of in-situ or invasive malignancy were present in 15 of the 19 cases (78%). Histologically, the tumor consisted of papillary proliferations protruding into and expanding the pancreatic ducts. Invasion into the surrounding pancreatic parenchyma was noted in 12 cases and chronic pancreatitis was present in 16 cases. Follow-up data (4 to 48 months) were available in 13 patients. Apart from 1 patient who died of other disease, all were still alive. Immunohistochemical study showed that p53 was positive in 6 cases, p16 in 5 cases and fascin in 8 cases. The expression of c-erbB-2 was all negative. Ki-67 index ranged from 1% to 80% (mean = 38%).
Malignant changes are not uncommon in IPMN. The prognosis after surgical resection however is better than that of conventional pancreatic adenocarcinoma. The overexpression of p53, p16 and fascin may be related to tumor progression. The possibility of malignant transformation needs to be considered if the Ki-67 index is over 15%. Early recognition by radiologic examination (including ERCP) and pancreatic cytology would be helpful in early diagnosis. Surgical resection represents the mainstay of treatment and long-term post-operative follow up is needed.
研究胰腺导管内乳头状黏液性肿瘤（IPMN）的临床病理特征及诊断方法。
对1999年至2007年间收治的19例IPMN患者进行光镜及免疫组化研究。
IPMN多见于男性（68%）。患者年龄较大（平均年龄59岁），主要位于胰头（60%）。肿瘤平均大小为4.2 cm（范围1至8 cm）。临床表现为上腹部疼痛（53%）、体重减轻（32%）、糖尿病（21%）、胰腺炎（21%）及黄疸（10%）。18例行胰腺切除术，其余1例仅接受了旁路手术。19例中有15例（78%）存在原位或浸润性恶性特征。组织学上，肿瘤由突入并扩张胰管的乳头状增生构成。12例可见侵犯周围胰腺实质，16例存在慢性胰腺炎。13例患者有随访资料（4至48个月）。除1例死于其他疾病外，其余患者均存活。免疫组化研究显示，6例p53阳性，5例p16阳性，8例fascin阳性。c-erbB-2表达均为阴性。Ki-67指数范围为1%至80%（平均38%）。
IPMN中恶性变并不少见。然而，手术切除后的预后优于传统胰腺腺癌。p53、p16及fascin的过表达可能与肿瘤进展有关。若Ki-67指数超过15%，需考虑恶变可能性。通过放射学检查（包括ERCP）及胰腺细胞学进行早期识别有助于早期诊断。手术切除是主要治疗方法，术后需长期随访。
