Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
Histopathology. 2013 Feb;62(3):465-71. doi: 10.1111/his.12023. Epub 2012 Nov 8.
Solid pseudopapillary neoplasm of the pancreas (SPN) is a rare low-grade malignant neoplasm. To our knowledge, SPN with prominent atypical multinucleated giant tumour cells (MNGTCs) has not yet been reported.
We identified four cases of SPN with prominent atypical MNGTCs in a cohort of 62 cases of SPN (6.5%). The MNGTCs contained multiple enlarged, hyperchromatic, irregular nuclei with ample eosinophilic cytoplasm, typically present in the solid area of the tumour. The MNGTCs had an immunohistochemical profile typical of the conventional SPN and were positive for vimentin, β-catenin, CD10 and progesterone receptor, but negative for pan-cytokeratin, chromogranin, synaptophysin, trypsin, Ki-67 and CD68 in all four cases. Patients of SPN with prominent MNGTCs were older than those with conventional SPN (P = 0.01); tumours were discovered incidentally by imaging studies for an unrelated disease in all four cases, and with a female to male ratio of 1:1. The proliferation index (Ki-67) was <1% in all four cases. None of the three patients for whom information was available developed recurrence during follow-up of 2.7, 3.8 and 5.0 years.
The presence of MNGTCs in SPN most probably represents degenerative change of the tumour cells and does not seem to affect the prognosis.
胰腺实性假乳头状瘤（SPN）是一种罕见的低度恶性肿瘤。据我们所知，具有显著非典型多核巨细胞肿瘤细胞（MNGTCs）的 SPN 尚未报道。
我们在 62 例 SPN 队列中发现了 4 例具有显著非典型 MNGTCs 的 SPN（6.5%）。MNGTCs 含有多个增大、深染、不规则的核，具有丰富的嗜酸性细胞质，通常存在于肿瘤的实性区域。MNGTCs 的免疫组织化学特征与传统 SPN 典型，均为波形蛋白、β-连环蛋白、CD10 和孕激素受体阳性，但在所有 4 例中均为广谱细胞角蛋白、嗜铬粒蛋白、突触素、胰蛋白酶、Ki-67 和 CD68 阴性。具有显著 MNGTCs 的 SPN 患者比具有传统 SPN 的患者年龄更大（P=0.01）；在所有 4 例中，肿瘤都是在因其他无关疾病进行影像学研究时偶然发现的，女性与男性的比例为 1:1。所有 4 例的增殖指数（Ki-67）均<1%。在随访 2.7、3.8 和 5.0 年期间，3 例中可获得信息的患者均未复发。
SPN 中 MNGTCs 的存在很可能代表肿瘤细胞的退行性变化，似乎不会影响预后。
