Department of Pathology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, Japan.
Virchows Arch. 2010 May;456(5):587-93. doi: 10.1007/s00428-010-0893-9. Epub 2010 Feb 25.
A 37-year-old Japanese man with a solid and cystic pancreatic mass was referred to our hospital. Computed tomography revealed a well-demarcated solid and cystic mass measuring approximately 3.0 cm in diameter in the pancreatic body. The patient underwent middle segment pancreatectomy, and the retrieved tumor specimen was found to be a well-demarcated solid and cystic lesion measuring 3.0 x 3.0 cm. On histological examination, the cyst walls were found to be lined with a monolayer of non-atypical tall columnar epithelial cells. The solid areas surrounded the cystic ones and showed storiform proliferation of spindle cells that contained round, oval, or elongated nuclei and were present among abundant collagen fibers. The solid areas sent phylloid projections into the cystic spaces and the main pancreatic duct. The spindle cells were found to be diffusely positive for alpha-smooth muscle actin, desmin, and h-caldesmon on immunohistochemical analysis. Electron microscopy revealed that these cells possessed well-developed myofilaments with dense bodies, pinocytic vesicles, and basal lumina. Neither metastasis nor local invasion was detected. After the operation (4 years), tumor recurrence has not occurred. The main differential diagnoses of spindle cell tumors are leiomyomas, leiomyosarcomas, inflammatory myofibroblastic tumors, solitary fibrous tumors, extra-gastrointestinal stromal tumors, and schwannomas. However, the histological findings in the present case differed from those of these tumors. The present lesion is the first reported case of a primary pancreatic phyllodes tumor.
一位 37 岁的日本男性，胰腺有实性和囊性肿块，被转介到我们医院。计算机断层扫描显示胰腺体部有一个边界清楚的实性和囊性肿块，直径约 3.0 厘米。患者接受了中段胰腺切除术，切除的肿瘤标本边界清楚，为实性和囊性病变，大小为 3.0x3.0 厘米。组织学检查发现，囊壁内衬单层非典型高柱状上皮细胞。实性区域环绕囊性区域，表现为梭形细胞的席纹状增生，梭形细胞含有圆形、椭圆形或长形核，存在于丰富的胶原纤维之间。实性区域向囊性腔和主胰管呈叶状突起。免疫组织化学分析显示，梭形细胞弥漫性表达α-平滑肌肌动蛋白、结蛋白和 h-钙调蛋白。电子显微镜显示这些细胞具有发育良好的肌丝，含有密体、吞饮小泡和基底腔。既没有转移也没有局部侵犯。手术后（4 年），肿瘤未复发。梭形细胞肿瘤的主要鉴别诊断包括平滑肌瘤、平滑肌肉瘤、炎性肌纤维母细胞瘤、孤立性纤维瘤、胃肠道外间质瘤和神经鞘瘤。然而，本例的组织学发现与这些肿瘤不同。本病变是首例原发性胰腺叶状肿瘤报告。
