Yamashita Shoko, Ikemoto Tetsuya, Morine Yuji, Imura Satoru, Iwahashi Shuichi, Saito Yu, Yamada Shinichiro, Yoshimoto Toshiaki, Tsuneyama Koichi, Shimada Mitsuo
Department of Digestive and Transplant Surgery, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan.
Department of Pathology and Laboratory Medicine, Tokushima University, Tokushima, Japan.
Surg Case Rep. 2019 Jul 23;5(1):117. doi: 10.1186/s40792-019-0673-y.
Diagnosis of cystic tumor of the pancreas is based on the World Health Organization criteria that classify pancreatic cystadenomas into four types: intra-ductal papillary mucinous neoplasms, mucinous cystic neoplasms (MCNs), serous cystic neoplasms, and solid pseudo-papillary neoplasms depending on their secretion and presence of ovarian-like stroma. Recently, Albores-Saavedra identified non-mucinous cystadenomas of the pancreas with pancreato-biliary phenotype and ovarian-like stroma. This precipitated examination of the proportions of these rare tumors in patients treated at Tokushima University Hospital.
Case 1 was a 40-year-old woman with a cystic tumor in the tail of the pancreas. Computed tomography (CT) revealed a diffuse and non-enhanced cystic tumor in the tail of the pancreas. This tumor was diagnosed as a simple cyst at this point. However, 2 years later, the tumor had increased in size by 3 cm. Thus, laparoscopic distal pancreatectomy was performed. The content of the cyst was serous. The epithelial cells were lined with a single layer of cuboidal cells and the tumor had ovarian-like stroma pathologically. The final pathological diagnosis was non-mucinous cystadenoma of the pancreas with ovarian-like stroma. In Case 2, a cystic tumor in the pancreas was found by medical examination in a woman in her sixties who presented without symptoms. CT showed a 1.5-cm cystic tumor in the tail and body of the pancreas and a septum in the cyst. Nine years later, the tumor had grown to 2.4 cm in diameter and had a clear septum in the cyst. This tumor was diagnosed preoperatively as MCN. Thus, laparoscopic distal pancreatectomy was performed. The cyst contained serous fluid. Microscopic examination showed no ovarian-like stroma and the epithelial cells were lined by a single layer of cuboidal cells. The final pathological diagnosis was non-mucinous cystadenoma of the pancreas with ovarian-like stroma.
Accurate preoperative diagnosis of this type of pancreatic cystic tumor may be difficult, although it occurs more often than expected. Non-mucinous cystadenomas of the pancreas with ovarian-like stroma need to be considered as a differential diagnosis.
胰腺囊性肿瘤的诊断依据世界卫生组织标准，该标准根据胰腺囊腺瘤的分泌物及是否存在卵巢样间质，将其分为四种类型：导管内乳头状黏液性肿瘤、黏液性囊性肿瘤（MCNs）、浆液性囊性肿瘤和实性假乳头状肿瘤。最近，阿尔沃雷斯 - 萨维德拉发现了具有胰胆管表型和卵巢样间质的胰腺非黏液性囊腺瘤。这促使对德岛大学医院接受治疗的患者中这些罕见肿瘤的比例进行了检查。
病例1是一名40岁女性，胰腺尾部有一个囊性肿瘤。计算机断层扫描（CT）显示胰腺尾部有一个弥漫性、无强化的囊性肿瘤。此时该肿瘤被诊断为单纯性囊肿。然而，2年后，肿瘤大小增加了3厘米。因此，进行了腹腔镜远端胰腺切除术。囊肿内容物为浆液性。上皮细胞为单层立方细胞，病理检查显示肿瘤有卵巢样间质。最终病理诊断为具有卵巢样间质的胰腺非黏液性囊腺瘤。病例2是一名60多岁无症状女性，体检时发现胰腺有一个囊性肿瘤。CT显示胰腺尾部和体部有一个1.5厘米的囊性肿瘤，囊肿内有隔膜。9年后，肿瘤直径增长到2.4厘米，囊肿内有清晰的隔膜。该肿瘤术前诊断为MCN。因此，进行了腹腔镜远端胰腺切除术。囊肿内含有浆液性液体。显微镜检查未发现卵巢样间质，上皮细胞为单层立方细胞。最终病理诊断为具有卵巢样间质的胰腺非黏液性囊腺瘤。
尽管这种类型的胰腺囊性肿瘤比预期更常见，但术前准确诊断可能困难。具有卵巢样间质的胰腺非黏液性囊腺瘤需要作为鉴别诊断加以考虑。
