Department of Pathology, The Ohio State University Medical Center, Columbus, OH 43210-1218, USA.
Am J Clin Pathol. 2012 Mar;137(3):414-22. doi: 10.1309/AJCPCXW7QUG9EFTO.
Hematologic malignancies often involve the pancreas, causing potential diagnostic pitfalls and, rarely, potentially avoidable surgical resection. We review the spectrum of hematologic malignancies involving the pancreas and describe features useful in preoperative distinction from adenocarcinoma. Archived clinical, pathologic, and radiologic data (1965 to present) for hematologic malignancies involving the pancreas were reviewed and compared with the data for 157 surgically resected pancreatic adenocarcinomas. Of 42 cases, 27 (64%) were clinically "suspicious" for hematologic malignancies. Of the remaining 15 cases, 4 patients underwent resection for presumed pancreatic adenocarcinoma. Isolated pancreatic masses proved most difficult to identify clinically. Significant factors in distinguishing hematologic malignancies from adenocarcinoma included history of hematologic malignancy, young age, large tumor size, low CA19-9 level, B symptoms, and lack of jaundice or diabetes mellitus. Various hematologic malignancies involve the pancreas, most commonly diffuse large B-cell lymphoma. Pancreatic masses are usually correctly identified clinically. Preoperative and operative sampling is strongly recommended when hematologic malignancies cannot be excluded.
血液系统恶性肿瘤常累及胰腺，导致潜在的诊断陷阱，且罕见地导致本可避免的手术切除。我们回顾了累及胰腺的血液系统恶性肿瘤的范围，并描述了有助于术前与腺癌鉴别的特征。我们对 1965 年至当前累及胰腺的血液系统恶性肿瘤的临床、病理和影像学存档数据进行了回顾，并与 157 例经手术切除的胰腺腺癌的数据进行了比较。42 例中，27 例（64%）临床上“疑似”血液系统恶性肿瘤。在其余 15 例中，4 例因疑似胰腺腺癌而行切除术。孤立性胰腺肿块在临床上最难识别。将血液系统恶性肿瘤与腺癌区分开来的重要因素包括血液系统恶性肿瘤病史、年轻、肿瘤体积大、CA19-9 水平低、B 症状以及无黄疸或糖尿病。各种血液系统恶性肿瘤累及胰腺，最常见的是弥漫性大 B 细胞淋巴瘤。胰腺肿块通常可在临床上正确识别。当不能排除血液系统恶性肿瘤时，强烈建议进行术前和术中取样。
