The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, JHOC 3140E, 601 N Caroline St, Baltimore, MD 21287.
Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD.
AJR Am J Roentgenol. 2020 May;214(5):1092-1100. doi: 10.2214/AJR.19.21824. Epub 2020 Mar 4.
The purpose of this study is to compare the CT features of colloid carcinoma and tubular adenocarcinoma of the pancreas arising in association with intraductal papillary mucinous neoplasms (IPMNs). The preoperative CT images of 85 patients with histopathologically proven IPMNs and associated invasive adenocarcinoma located next to each other were retrospectively reviewed. Twenty-nine patients (34.1%; 19 men and 10 women; mean [± SD] age, 68.0 ± 9.5 years) had invasive colloid carcinoma, and 56 patients (65.9%; 31 men and 25 women; mean age, 70.8 ± 10.6 years) had invasive tubular adenocarcinoma. We compared the following CT features between the two groups: IPMN type, main pancreatic duct (MPD) and common bile duct diameters, diameter and characteristics of the largest cystic lesion for branch duct and mixed-type IPMNs, presence of an extracystic or extraductal solid mass next to the cystic lesion or MPD, morphologic features of the upstream MPD in relation to the cystic lesion or solid mass, and presence of a fistula to the adjacent organs. An MPD size of 9.5 mm or greater, a largest cystic lesion diameter of 28 mm or greater, location in the head or neck, septation, calcification, presence of a mural nodule(s) within a cystic lesion or MPD, and presence of a fistula were all more commonly associated with colloid carcinoma. In contrast, presence of an extracystic or extraductal solid mass and an abrupt change in the caliber of the dilated MPD were associated with tubular adenocarcinoma. The best CT feature for differentiating between the two groups was the morphologic features of the upstream MPD in relation to the cystic lesion or solid mass (sensitivity, 81.3%; specificity, 92.3%). Preoperative CT is helpful in differentiating two types of invasive carcinoma arising in association with IPMNs. These findings are clinically important because prognosis is better for colloid carcinoma than for tubular adenocarcinoma.
本研究旨在比较与胰管内乳头状黏液性肿瘤（IPMN）相关的胰腺胶样癌和管状腺癌的 CT 特征。回顾性分析了 85 例经组织病理学证实的 IPMN 及其相邻侵袭性腺癌的术前 CT 图像。29 例（34.1%；19 名男性和 10 名女性；平均年龄[±标准差]，68.0±9.5 岁）为侵袭性胶样癌，56 例（65.9%；31 名男性和 25 名女性；平均年龄，70.8±10.6 岁）为侵袭性管状腺癌。比较两组以下 CT 特征：IPMN 类型、主胰管（MPD）和胆总管直径、分支型和混合型 IPMN 最大囊性病变的直径和特征、囊性病变或 MPD 旁是否存在囊外或胰外实性肿块、与囊性病变或实性肿块相关的上游 MPD 的形态特征、是否存在通向相邻器官的瘘管。MPD 直径≥9.5mm、最大囊性病变直径≥28mm、位于头颈部、分隔、钙化、囊性病变或 MPD 内存在壁结节、存在瘘管与胶样癌更相关。相反，存在囊外或胰外实性肿块和扩张的 MPD 管腔突然变化与管状腺癌相关。鉴别两组的最佳 CT 特征是与囊性病变或实性肿块相关的上游 MPD 的形态特征（敏感性 81.3%；特异性 92.3%）。术前 CT 有助于鉴别与 IPMN 相关的两种侵袭性癌。这些发现具有重要的临床意义，因为胶样癌的预后优于管状腺癌。
