Misra Sunayana, Saran R K, Srivastava Siddharth, Barman Sandip, Dahale Amol
Department of Pathology, GB Pant Institute of Post Graduate Medical Education and Research, 1 Jawahar Lal Nehru Marg, New Delhi, India.
Department of Gastroenterology, GB Pant Institute of Post Graduate Medical Education and Research, 1 Jawahar Lal Nehru Marg, New Delhi, India.
Diagn Cytopathol. 2019 Jun;47(6):531-540. doi: 10.1002/dc.24145. Epub 2019 Jan 24.
Pancreatic solid pseudopapillary tumor (SPN) and pancreatic neuroendocrine tumors (Pan-NET) have close resemblance on imaging and cytomorphology, though they differ in their prognosis and treatment strategy. SPNs are low-grade indolent tumors while Pan-NETs harbor malignant potential with propensity to metastasize. We aim to differentiate SPN from Pan-NET based on cyto-morphology; to classify nuclear membrane (NM) irregularities or nuclear folds into four grades and see whether they bear any difference with respect to the two entities.
Eighteen and ten confirmed cases of SPN and Pan-NET were included in the study. Smears were assessed for architecture, background changes, cellular, and nuclear features, which were compared between the two study groups. Nuclear folds were classified into four grades. Nuclear folds and nuclear grooves were also compared between the two groups.
All SPN patients were females; mean age of 28 years. Pan-NET patients had equal male to female ratio; mean age of 46 years. Both SPN (78%) and Pan-NET (71%) showed predilection for pancreatic head. Mean size of lesion was 4.8 cm and 3.1 cm in SPN and Pan-NET groups. Papillary pattern, branching capillaries, degenerative background were significantly more prominent in SPN; sudden anisonucleosis and cytoplasmic granularity in Pan-NET. Metachromatic matrix, hyaline globules, and nuclear grooves were noted exclusively in SPNs. Nuclear fold grades 2 and 3 were more characteristic of SPN than Pan-NET (P = 0.041 and 0.002, respectively).
Cytomorphology is vital in differentiating SPN from Pan-NET with nuclear folds being an important nuclear feature.
胰腺实性假乳头状瘤（SPN）与胰腺神经内分泌肿瘤（Pan-NET）在影像学和细胞形态学上有相似之处，但预后和治疗策略不同。SPN是低度惰性肿瘤，而Pan-NET具有恶性潜能且有转移倾向。我们旨在根据细胞形态学区分SPN和Pan-NET；将核膜（NM）不规则或核褶皱分为四个等级，看看它们在这两种实体上是否存在差异。
本研究纳入了18例确诊的SPN病例和10例确诊的Pan-NET病例。对涂片进行结构、背景变化、细胞和核特征评估，并在两个研究组之间进行比较。核褶皱分为四个等级。还比较了两组之间的核褶皱和核沟。
所有SPN患者均为女性，平均年龄28岁。Pan-NET患者男女比例相等，平均年龄46岁。SPN（78%）和Pan-NET（71%）均好发于胰头。SPN组和Pan-NET组病变的平均大小分别为4.8 cm和3.1 cm。乳头状模式、分支毛细血管、退行性背景在SPN中更为显著；Pan-NET中可见突然的核大小不均和细胞质颗粒。异染基质、透明小球和核沟仅在SPN中出现。核褶皱2级和3级在SPN中比在Pan-NET中更具特征性（P分别为0.041和0.002）。
细胞形态学在区分SPN和Pan-NET中至关重要，核褶皱是一个重要的核特征。
