Centeno B A, Lewandrowski K B, Warshaw A L, Compton C C, Southern J F
Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston 02114.
Am J Clin Pathol. 1994 Apr;101(4):483-7. doi: 10.1093/ajcp/101.4.483.
Pancreatic cystic lesions include inflammatory pseudocysts, benign serous cystadenomas, and mucinous neoplasms, some of which are malignant. Cytologic analysis of cyst fluid has been proposed to diagnose pancreatic cysts before definitive therapy. The authors report an analysis of 31 pancreatic cyst aspirates: 9 pseudocysts, 5 serous cystadenomas, 8 mucinous cystic neoplasms, 4 mucinous cystadenocarcinomas, 2 papillary cystadenocarcinomas, 1 mucinous ductal adenocarcinoma with cystic degeneration, and 2 cystic islet cell tumors. All pseudocysts were correctly classified as probable inflammatory lesions, because of the presence of abundant acute inflammation and histiocytes and the absence of glandular epithelium. Three of five serous cystadenomas were correctly classified, based on the presence of small cuboidal cells in clusters with microvesicular cytoplasm containing glycogen. Eleven of 12 mucinous tumors contained round cells with large cytoplasmic mucin vacuoles or columnar cells containing cytoplasmic mucin. Malignancy was diagnosed in 5 of 7 carcinomas, 1 case was classified as suspicious for malignancy, and 1 case was nondiagnostic because of the absence of a cellular component. The authors concluded that pancreatic cyst fluid cytologic analysis is useful in differentiating mucinous from nonmucinous pancreatic cysts and may provide definitive evidence of malignancy. In some cases, serous cystadenoma can be diagnosed based on cytologic analysis. An inflammatory smear without epithelial cells suggests a pseudocyst, but these findings are nonspecific, as a similar pattern may occur when a cystic neoplasm undergoes degenerative changes. Therefore, pseudocyst remains a diagnosis of exclusion.
胰腺囊性病变包括炎性假囊肿、良性浆液性囊腺瘤和黏液性肿瘤，其中一些是恶性的。有人提出对囊液进行细胞学分析，以便在进行确定性治疗前诊断胰腺囊肿。作者报告了对31份胰腺囊肿抽吸物的分析结果：9份为假囊肿，5份为浆液性囊腺瘤，8份为黏液性囊性肿瘤，4份为黏液性囊腺癌，2份为乳头状囊腺癌，1份为伴有囊性变的黏液性导管腺癌，2份为囊性胰岛细胞瘤。所有假囊肿均被正确分类为可能的炎性病变，因为存在大量急性炎症和组织细胞，且无腺上皮。5份浆液性囊腺瘤中有3份根据存在成簇的小立方形细胞，其微泡状细胞质中含有糖原而被正确分类。12份黏液性肿瘤中有11份含有圆形细胞，其细胞质中有大的黏液空泡，或含有细胞质黏液的柱状细胞。7份癌中有5份被诊断为恶性，1例被分类为可疑恶性，1例因无细胞成分而无法诊断。作者得出结论，胰腺囊液细胞学分析有助于区分黏液性和非黏液性胰腺囊肿，并可能提供恶性肿瘤的确切证据。在某些情况下，浆液性囊腺瘤可根据细胞学分析作出诊断。无上皮细胞的炎性涂片提示假囊肿，但这些发现不具有特异性，因为当囊性肿瘤发生退行性改变时可能出现类似的模式。因此，假囊肿仍然是一种排除性诊断。
