Kang Chang Moo, Cho Arthur, Kim Hyunki, Chung Young Eun, Hwang Ho Kyoung, Choi Sung Hoon, Lee Woo Jung
Department of Surgery, Yonsei University College of Medicine Pancreaticobiliary Cancer Clinic, Institute of Gastroenterology, Severance Hospital, Seoul, Republic of Korea.
Department of Radiology, Yonsei University College of Medicine Pancreaticobiliary Cancer Clinic, Institute of Gastroenterology, Severance Hospital, Seoul, Republic of Korea.
Pancreatology. 2014 Nov-Dec;14(6):515-23. doi: 10.1016/j.pan.2014.08.003. Epub 2014 Aug 23.
There are limited numbers of PET studies of solid pseudopapillary tumors (SPT) of the pancreas.
We reviewed the medical records of 37 patients who underwent resection of pancreatic SPT and had been preoperatively evaluated by (18)F-FDG PET or PET/CT scan. Immunohistochemical analysis of glucose transporter-1 (GLUT-1) and hexokinase II (HK-II) was performed.
SPT could be categorized into five types according to the morphologic characteristics observed in PET images. Type I (hot FDG uptake in the entire tumor portion) was the most frequent (13, 34.2%), followed by type IV (focal uptake, 12, 31.6%), II (focal defect, 8, 21.1%), III (multiple and geographic uptake, 3, 7.9%), and V (total defective type, 1, 2.6%). The SUVmax in the solid portion of the SPT was 5.3 ± 4.1. The clinical pattern of FDG uptake in SPT was not associated with histopathologic features suggesting malignant potential. The SUVmax of SPT followed a pattern according to pattern of FDG uptake (R(2) = 0.203, p = 0.055), and was significantly associated with adjusted tumor volume (p = 0.001). GLUT-1 was not expressed in SPT, and only eight patients (12.3%) showed mild to moderate expression of HK-II, which was associated with the clinical pattern of SPT in PET images (p < 0.05).
SPT of the pancreas could be categorized according to the morphologic patterns observed in PET images. The clinical significance of FDG uptake, glucose metabolism, and clinical usefulness of PET scan in SPT need to be further investigated, and thus this tumor remains a surgical enigma.
胰腺实性假乳头状瘤（SPT）的正电子发射断层显像（PET）研究数量有限。
我们回顾了37例行胰腺SPT切除术且术前行（18）F - 氟代脱氧葡萄糖（FDG）PET或PET/CT扫描评估的患者的病历。进行了葡萄糖转运蛋白1（GLUT - 1）和己糖激酶II（HK - II）的免疫组化分析。
根据PET图像中观察到的形态学特征，SPT可分为五种类型。I型（肿瘤全部区域FDG摄取高）最为常见（13例，34.2%），其次是IV型（局灶性摄取，12例，31.6%）、II型（局灶性缺损，8例，21.1%）、III型（多发及地图样摄取，3例，7.9%）和V型（完全缺损型，1例，2.6%）。SPT实性部分的最大标准摄取值（SUVmax）为5.3±4.1。SPT中FDG摄取的临床模式与提示恶性潜能的组织病理学特征无关。SPT的SUVmax根据FDG摄取模式呈现一定规律（R(2)=0.203，p = 0.055），且与校正后的肿瘤体积显著相关（p = 0.001）。SPT中未检测到GLUT - 1表达，仅8例患者（12.3%）显示HK - II呈轻度至中度表达，这与PET图像中SPT的临床模式相关（p < 0.05）。
胰腺SPT可根据PET图像中观察到的形态学模式进行分类。SPT中FDG摄取、葡萄糖代谢的临床意义以及PET扫描的临床应用价值仍需进一步研究，因此该肿瘤仍是一个手术难题。
