Gudmundsson S, Agnarsson B A, Gunnlaugsson G, Magnusson J
Laeknabladid. 1995 Jun;81(6):469-76.
Cystic neoplasms of the pancreas are pathologically divided into macrocystic and microcystic adenomas. Macrocystic adenomas are multilocular, composed of large cysts (>2 cm), with or without septa, lined with columnar mucin-producing epithelium. This type has malignant potential. The microcystic adenomas are composed of many tiny cysts (<2 cm) lined by small cuboidal cells containing glycogen but little or no mucin. This adenoma is completely benign and is therefore important to differentiate from the former. Cystadenomas represent 10-15% of cystic lesions of the pancreas. Roughly one-half of the cystadenomas of the pancreas are found to be microcystic. The remainder is accounted for by the mucinous cystic neoplasms, either macrocystic adenomas or cystadenocarcinomas. These adenomas occur most frequently in middle aged women. Upper abdominal pain and weight loss are often the presenting symptoms. An abdominal mass can often be palpated during physical examination of these patients. Ultrasound and CT of the abdomen are the most useful diagnostic tools in the evaluation of cystic lesions of the pancreas. CT can also be helpful in differentiating microcystic from macrocystic adenomas. It is possible to do a CT or ultrasound guided percutaneous aspiration for diagnosis of the lesions. This technique permits preoperative cytologic and biochemical analysis of the cyst content. Surgery however is often necessary for accurate diagnosis where the tumor is biopsied for histology. The primary pancreatic lesions to be considered in the differential diagnosis include pseudocyst, whether of inflammatory or traumatic origin, congenital cysts, ductal adenocarcinoma or islet cell tumors. Some agree that surgical resection may not be mandatory if an accurate diagnosis of microcystic adenoma can be made. Others emphasize that all pancreatic cystadenomas can have malignant potential and that total excision should be the treatment of choice. Both macrocystic adenomas and cystadenocarcino notmas have a slow and indolent course and tend to be well resectable in spite of late diagnosis. Three cases of pancreatic cystadenomas have been diagnosed in Iceland since 1972. These cases are presented here with a review of the literature.
胰腺囊性肿瘤在病理上分为大囊性腺瘤和微囊性腺瘤。大囊性腺瘤为多房性，由大囊肿（>2cm）组成，有或无间隔，内衬柱状产粘蛋白上皮。此类型有恶变潜能。微囊性腺瘤由许多微小囊肿（<2cm）组成，内衬小立方形细胞，含糖原但很少或不含粘蛋白。这种腺瘤完全良性，因此与前者鉴别很重要。囊腺瘤占胰腺囊性病变的10% - 15%。胰腺囊腺瘤约一半为微囊性腺瘤。其余为黏液性囊性肿瘤，即大囊性腺瘤或囊腺癌。这些腺瘤最常见于中年女性。上腹部疼痛和体重减轻常为首发症状。体格检查时这些患者常可触及腹部肿块。腹部超声和CT是评估胰腺囊性病变最有用的诊断工具。CT也有助于区分微囊性腺瘤和大囊性腺瘤。可行CT或超声引导下经皮穿刺抽吸以诊断病变。该技术可对囊肿内容物进行术前细胞学和生化分析。然而，为进行肿瘤组织学活检以准确诊断，手术往往是必要的。鉴别诊断中需考虑的主要胰腺病变包括假性囊肿，无论其为炎症性或创伤性起源、先天性囊肿、导管腺癌或胰岛细胞瘤。一些人认为，如果能准确诊断为微囊性腺瘤，手术切除可能并非必需。另一些人则强调，所有胰腺囊腺瘤都有恶变潜能，全切除应是首选治疗方法。大囊性腺瘤和囊腺癌病程缓慢且隐匿，尽管诊断较晚，但往往可切除。自1972年以来冰岛已诊断出3例胰腺囊腺瘤。本文报告这些病例并复习相关文献。
