Warshaw A L, Compton C C, Lewandrowski K, Cardenosa G, Mueller P R
Surgical Services, Massachusetts General Hospital, Boston 02114.
Ann Surg. 1990 Oct;212(4):432-43; discussion 444-5. doi: 10.1097/00000658-199010000-00006.
Within a 12-year period we treated 67 patients (49 women, 18 men; mean age, 61 years) with cystic neoplasms of the pancreas, including 18 serous cystic adenomas, 15 benign mucinous cystic neoplasms, 27 mucinous cystadenocarcinomas, 3 papillary cystic tumors, 2 cystic islet cell tumors, and 2 cases of mucinous ductal ectasia. Mean tumor size was 6 cm (2 to 16 cm). In 39% the patients had no symptoms, and in 37% the lesions had been misdiagnosed as a pseudocyst. Computed tomography was useful for detection, for distinguishing the microcystic subgroup of serous cystadenoma, and for showing rim calcification (all 7 cases were malignant) but was not reliable for distinguishing neoplasm from pseudocyst, serous from mucinous tumors, or benign from malignant. Arteriography showed hypervascularity in 4 of 10 serous adenomas, 3 of 11 mucinous carcinomas, and 1 of 1 papillary cystic tumors. Endoscopic pancreatography showed no communication with the cyst cavity in 37 of 37 cases of cystic neoplasms but opacified the ectatic ducts in 2 of 2 cases of mucinous ductal ectasia. Stenosis or obstruction of the pancreatic duct indicated cancer. The tumor was resected by distal pancreatectomy in 25 patients, by proximal resection in 29, and by total pancreatectomy in one, with no operative deaths. Forty-four per cent of the tumors were malignant. In 10 cases the tumor was unresectable because of local extension or distant metastases, and those patients died at a mean of 4 months. Seventy-five per cent of those resected for cure are alive without evident recurrence. Because the epithelial lining of the tumor was partially (5% to 98%) absent in 40% to 72% of cases of the major tumor types, and the mucinous component comprised only about 65% of mucinous cystadenoma lining, misdiagnoses on frozen and even permanent sections were made. Mitoses and histologic solid growth correlated with malignancy. Neuroendocrine elements were seen in 87% of benign and 47% of malignant mucinous tumors. It is recommended that the terms macrocystic and microcystic be abandoned in favor of the histologic designations serous and mucinous. Incomplete examination of the cyst wall can be misleading, however. It is suggested that mucinous ductal ectasia be recognized separately from cystic tumors and that all of these lesions be resected, with the possible exception of asymptomatic confirmed serous cystadenomas.
在12年期间，我们治疗了67例胰腺囊性肿瘤患者（49例女性，18例男性；平均年龄61岁），其中包括18例浆液性囊腺瘤、15例良性黏液性囊性肿瘤、27例黏液性囊腺癌、3例乳头状囊性肿瘤、2例囊性胰岛细胞瘤以及2例黏液性导管扩张症。肿瘤平均大小为6 cm（2至16 cm）。39%的患者无症状，37%的病变曾被误诊为假性囊肿。计算机断层扫描（CT）有助于检测、区分浆液性囊腺瘤的微囊性亚组以及显示边缘钙化（所有7例均为恶性），但在区分肿瘤与假性囊肿、浆液性肿瘤与黏液性肿瘤或良性与恶性方面并不可靠。动脉造影显示，10例浆液性腺瘤中有4例、11例黏液性癌中有3例以及1例乳头状囊性肿瘤中有1例表现为血管增多。内镜胰胆管造影显示（37例囊性肿瘤中的）37例囊肿腔与胰管不相通，但（2例黏液性导管扩张症中的）2例扩张导管显影。胰管狭窄或阻塞提示癌症。25例患者行胰体尾切除术，29例行胰头切除术，1例行全胰切除术，无手术死亡病例。44%的肿瘤为恶性。10例患者因局部侵犯或远处转移无法切除肿瘤，这些患者平均4个月后死亡。75%接受根治性切除的患者存活且无明显复发。由于在主要肿瘤类型的40%至72%病例中肿瘤上皮衬里部分（5%至98%）缺失，且黏液性成分仅占黏液性囊腺瘤衬里的约65%，因此在冷冻切片甚至永久切片上都出现了误诊。有丝分裂和组织学实性生长与恶性相关。在87%的良性和47%的恶性黏液性肿瘤中可见神经内分泌成分。建议摒弃“大囊性”和“微囊性”术语，而采用组织学名称“浆液性”和“黏液性”。然而，对囊肿壁检查不完整可能会产生误导。建议将黏液性导管扩张症与囊性肿瘤分开识别，并且除无症状的确诊浆液性囊腺瘤外，所有这些病变均应切除。
