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[胰腺腺泡细胞癌的临床病理特征]

[Clinicopathologic characterisitics of pancreatic acinar cell carcinomas].

作者信息

Ding X H, Wang Z B, Qiu X M

机构信息

Department of Pathology, PLA General Hospital, Beijing 100853, China.

出版信息

Zhonghua Bing Li Xue Za Zhi. 2018 Apr 8;47(4):274-278. doi: 10.3760/cma.j.issn.0529-5807.2018.04.009.

Abstract

To investigate clinical, pathological and immunohistochemical features of pancreatic acinar cell carcinoma. A retrospective review of surgical and pathological databases between 2011 and 2016 at PLA General Hospital was collected and 14 cases of acinar cell carcinoma (ACC) of the pancreas were identified. EnVision immunohistochemistry was used to detect the expression of Trypsin, bcl-10 and cytokeratin(CK) proteins. The patients included nine cases of pure ACC, 3 cases of mixed acinar ductal carcinoma, 1 case of mixed acinar-neuroendocrine carcinoma and acinar-ductal-neuroendocrine carcinoma, respectively. Tumors involved different anatomic locations of the pancreas, including eight involving the head of pancreas, four in the body and tail, one in the uncinate process and one in a heterotopic pancreas. Two patients had lymph node and liver metastases before surgery. Microscopically, the tumor was hypercellular with less fibroblastic proliferation and tumor cells arranged in acinar or solid pattern. The well differentiated tumor cells showed eosinophilic, granular cytoplasm with single prominent nucleoli, while the poorly differentiated tumor cells tended to grow in solid sheets. Immunohistochemically, the tumor cells were positive for pan-cytokeratin (14/14), Trypsin (12/14) and bcl-10 (11/14). Stains for CK7 and CK19 were negative (11/14 and 3/4). According to the pTNM staging, there were 7 cases at stageⅠ, 3 at stage ⅡA, 3 at stage Ⅲ and 1 at stage Ⅳ. With average postoperative follow-up of 6-58 months, the median disease-free survival time was 16 months. Pancreatic acinar cell carcinoma is a rare and relatively indolent malignant tumor with characteristic histopathological and immunohistochemical features. Accurate pathological diagnosis plays an important role in patients' treatment and evaluation of prognosis.

摘要

探讨胰腺腺泡细胞癌的临床、病理及免疫组化特征。回顾性收集2011年至2016年解放军总医院外科及病理数据库资料,共确诊14例胰腺腺泡细胞癌(ACC)。采用EnVision免疫组化法检测胰蛋白酶、bcl-10和细胞角蛋白(CK)蛋白的表达。患者包括9例单纯ACC、3例混合性腺泡导管癌、1例混合性腺泡神经内分泌癌和腺泡导管神经内分泌癌。肿瘤累及胰腺不同解剖部位,其中8例累及胰头,4例累及胰体和胰尾,1例累及钩突,1例位于异位胰腺。2例患者术前有淋巴结及肝转移。镜下,肿瘤细胞丰富,纤维组织增生较少,肿瘤细胞呈腺泡状或实性排列。高分化肿瘤细胞呈嗜酸性、颗粒状胞质,核仁单个明显,而低分化肿瘤细胞倾向于呈实性片状生长。免疫组化结果显示,肿瘤细胞pan-细胞角蛋白(14/14)、胰蛋白酶(12/14)和bcl-10(11/14)呈阳性。CK7和CK19染色阴性(11/14和3/4)。根据pTNM分期,Ⅰ期7例,ⅡA期3例,Ⅲ期3例,Ⅳ期1例。术后平均随访6 - 58个月,无病生存时间中位数为16个月。胰腺腺泡细胞癌是一种罕见且相对惰性的恶性肿瘤,具有特征性的组织病理学和免疫组化特征。准确的病理诊断对患者的治疗及预后评估具有重要作用。

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