Lombardo Carlo, Iacopi Sara, Menonna Francesca, Napoli Niccolò, Kauffmann Emanuele, Bernardini Juri, Cacciato Insilla Andrea, Boraschi Piero, Donati Francescamaria, Cappelli Carla, Campani Daniela, Caramella Davide, Boggi Ugo
Division of General and Transplant Surgery, University of Pisa, Pisa, Italy.
Division of Pathology, University of Pisa, Pisa, Italy.
Pancreatology. 2018 Jul;18(5):577-584. doi: 10.1016/j.pan.2018.06.001. Epub 2018 Jun 8.
BACKGROUND/OBJECTIVES: Despite diagnostic refinements, pancreatic resection (PR) is eventually performed in some patients with asymptomatic serous cystadenoma (A-SCA). The aim of this study was to define incidence and reasons of PR in A-SCA.
A retrospective analysis of a prospectively maintained database was performed for all the patients referred for pancreatic cystic lesions (PCL) between January 2005 and March 2016.
Overall, there were 1488 patients with PCL, including 1271 (85.4%) with incidental PCL (I-PCL). During the study period referral of I-PCL increased 8.5-fold. Surgery was immediately advised in 94 I-PCL (7.3%) and became necessary later on in 11 additional patients (0.9%), because of the development of symptoms. Overall, PR was performed in 105/1271 patients presenting with I-PCL (8.2%), including 27 with A-SCA (2.1%). All patients with A-SCA underwent ultrasonography and contrast-enhanced computed tomography. Magnetic resonance imaging was performed in 21 patients (77.8%), 18 F-FDG positron emission tomography in 8 (29.6%), endoscopic ultrasonography (EUS) in 2 (7.4%), and EUS-guided fine needle aspiration (EUS-FNA) in 1 (3.7%). These studies demonstrated a combination of atypical features such as solid tumor (3; 11.1%), oligo-/macrocystic tumor (24; 88.8%), mural nodules (14; 51.8%), enhancing cyst walls (17; 62.9%), dilation of the main pancreatic duct (3; 11.1%), and upstream pancreatic atrophy (1; 3.7%). Additionally, 14/27 patients (51.8%) were females with oligo-/macrocystic tumors located in the body-tail of the pancreas.
Management of patients with A-SCA entails a small risk of PR especially when these tumors demonstrate atypical radiologic features associated with confounding anatomic and demographic characteristics.
背景/目的：尽管诊断方法有所改进，但对于一些无症状浆液性囊腺瘤（A-SCA）患者最终仍需进行胰腺切除术（PR）。本研究旨在明确A-SCA患者行PR的发生率及原因。
对2005年1月至2016年3月期间所有因胰腺囊性病变（PCL）前来就诊的患者进行前瞻性维护数据库的回顾性分析。
总体而言，共有1488例PCL患者，其中1271例（85.4%）为偶然发现的PCL（I-PCL）。在研究期间，I-PCL的转诊增加了8.5倍。94例I-PCL（7.3%）患者立即被建议手术，另有11例患者（0.9%）后来因出现症状而有必要手术。总体而言，1271例I-PCL患者中有105例（8.2%）接受了PR，其中27例为A-SCA（2.1%）。所有A-SCA患者均接受了超声检查和增强CT检查。21例患者（77.8%）进行了磁共振成像，8例（29.6%）进行了18F-FDG正电子发射断层扫描，2例（7.4%）进行了内镜超声检查（EUS），1例（3.7%）进行了EUS引导下细针穿刺活检（EUS-FNA）。这些检查显示出一些非典型特征的组合，如实性肿瘤（3例；11.1%）、寡囊/多囊性肿瘤（24例；88.8%）、壁结节（14例；51.8%）、强化的囊壁（17例；62.9%）、主胰管扩张（3例；11.1%）和上游胰腺萎缩（1例；3.7%）。此外，14/27例患者（51.8%）为女性，寡囊/多囊性肿瘤位于胰体尾部。
A-SCA患者的治疗存在一定的PR风险，尤其是当这些肿瘤表现出与解剖和人口统计学特征混淆相关的非典型放射学特征时。
