Yong W H, Southern J F, Pins M R, Warshaw A L, Compton C C, Lewandrowski K B
Department of Pathology, Massachusetts General Hospital, Boston, 02114 USA.
Pancreas. 1995 May;10(4):342-6. doi: 10.1097/00006676-199505000-00004.
Cystic lesions of the pancreas include inflammatory pseudocysts, serous cystadenomas, and mucinous tumors, some of which are malignant. Preoperative clinical and radiological parameters are unreliable and may result in incorrect diagnosis and inappropriate treatment. Cyst fluid analysis for cytology, viscosity, carcino-embryonic antigen, CA 72-4, and CA 15-3 will distinguish mucinous from nonmucinous lesions and usually help in determining malignancy. Currently, there is no reliable method to differentiate inflammatory pseudocysts from serous cystadenomas. This distinction is important because the treatment of these two lesions is different; pseudocysts are either observed or drained, whereas serous tumors are usually resected. The tumor marker NB/70K was measured in aspirated cyst fluid from 13 inflammatory pseudocysts and 11 serous cystadenomas by a commercial immunoassay. Leukocyte esterase was measured using Chemstrip SG urine test strips and amylase and lipase on a routine chemistry analyzer. The cyst fluid NB/70K concentration was significantly higher in pseudocysts (mean, 555 U/ml; range, 42-1,926 U/ml) than in serous cystadenomas (mean, 12 U/ml; range 0-130 U/ml) and this difference was significant (p < 0.0002). Leukocyte esterase was detected in 7 of 11 pseudocysts but was absent in 10 of 10 serous tumors (p = 0.002). Amylase and lipase values were generally higher in pseudocysts but these markers were unreliable due to marked outliers. Cyst fluid NB/70K and leukocyte esterase are promising markers to help differentiate pseudocysts from serous tumors on percutaneous aspirates. When combined with previously reported cyst fluid parameters (amylase, lipase, cytology, and amylase isoenzymes), these two cystic lesions can be reliably distinguished.
胰腺囊性病变包括炎性假囊肿、浆液性囊腺瘤和黏液性肿瘤，其中一些是恶性的。术前临床和影像学参数不可靠，可能导致诊断错误和治疗不当。对囊液进行细胞学、黏稠度、癌胚抗原、CA 72 - 4和CA 15 - 3分析可区分黏液性和非黏液性病变，通常有助于确定是否为恶性。目前，尚无可靠方法区分炎性假囊肿和浆液性囊腺瘤。这种区分很重要，因为这两种病变的治疗方法不同；炎性假囊肿可观察或引流，而浆液性肿瘤通常需切除。采用商业免疫分析法检测了13例炎性假囊肿和11例浆液性囊腺瘤抽吸囊液中的肿瘤标志物NB/70K。使用Chemstrip SG尿试纸条检测白细胞酯酶，并在常规化学分析仪上检测淀粉酶和脂肪酶。炎性假囊肿的囊液NB/70K浓度（平均555 U/ml；范围42 - 1926 U/ml）显著高于浆液性囊腺瘤（平均12 U/ml；范围0 - 130 U/ml），差异有统计学意义（p < 0.0002）。11例炎性假囊肿中有7例检测到白细胞酯酶，而10例浆液性肿瘤中均未检测到（p = 0.002）。炎性假囊肿的淀粉酶和脂肪酶值通常较高，但由于存在明显异常值，这些标志物不可靠。囊液NB/70K和白细胞酯酶有望成为帮助经皮抽吸区分假囊肿和浆液性肿瘤的标志物。与先前报道的囊液参数（淀粉酶、脂肪酶、细胞学和淀粉酶同工酶）联合使用时，可可靠区分这两种囊性病变。
