Lewandrowski K B, Southern J F, Pins M R, Compton C C, Warshaw A L
Department of Pathology, Massachusetts General Hospital, Boston 02114.
Ann Surg. 1993 Jan;217(1):41-7. doi: 10.1097/00000658-199301000-00008.
Pancreatic cystic lesions include inflammatory pseudocysts, benign serous tumors, and mucinous neoplasms, some of which are malignant. Clinical and radiologic indices are often inadequate to discriminate reliably among these possibilities. In an attempt to develop new preoperative diagnostic criteria to assist in decisions regarding therapy, the authors have performed cyst fluid analysis for tumor markers (carcinoembryonic antigen: CEA, CA 125, and CA 19.9), amylase content, amylase isoenzymes, relative viscosity, and cytology on 26 pancreatic cysts. The cases included nine pseudocysts, five serous cystadenomas, 4 mucinous cystic neoplasms, 7 mucinous cystadenocarcinomas, and one mucinous ductal adenocarcinoma with cystic degeneration. Carcinoembryonic antigen levels were high (> 367) in all benign and malignant mucinous cysts, but were low (< 23) in the pseudocysts and benign serous cystadenomas, an indication that CEA discriminates between mucinous and nonmucinous cysts (p < 0.0001). Values for CA 125 were high in all malignant cysts, low in pseudocysts, and variable in mucinous cystic neoplasms and serous cystadenomas. Levels of Ca 19.9 were nondiscriminatory. Cyst fluid amylase and lipase content were variable but were generally high in pseudocysts and low in cystic tumors. Amylase isoenzyme analysis was useful to differentiate pseudocysts from cystic tumors. Measurement of the relative viscosity in cyst fluid showed high (> serum viscosity) values in 89% of mucinous tumors and low values (< serum) in all pseudocysts and serous cystadenomas (p < 0.01). Cytologic analysis of cyst fluids was of limited value in differentiating pseudocysts from serous cystadenoma, but in seven of eight mucinous tumors provided useful diagnostic information and correctly classified three of five malignant tumors. The authors conclude that cyst fluid analysis can provide a preoperative classification of these diagnostically difficult lesions. The combination of viscosity, CEA, CA 125, and cytology can reliably distinguish malignant cystic tumors and potentially premalignant mucinous cystic neoplasms from pseudocysts and serous cystadenomas. Amylase content with isoenzyme analysis is useful to identify pseudocysts.
胰腺囊性病变包括炎性假囊肿、良性浆液性肿瘤和黏液性肿瘤，其中一些是恶性的。临床和放射学指标往往不足以可靠地区分这些可能性。为了制定新的术前诊断标准以协助治疗决策，作者对26个胰腺囊肿进行了囊液分析，检测肿瘤标志物（癌胚抗原：CEA、CA 125和CA 19.9）、淀粉酶含量、淀粉酶同工酶、相对黏度和细胞学指标。病例包括9个假囊肿、5个浆液性囊腺瘤、4个黏液性囊性肿瘤、7个黏液性囊腺癌和1个伴有囊性变的黏液性导管腺癌。所有良性和恶性黏液性囊肿的癌胚抗原水平均较高（>367），而假囊肿和良性浆液性囊腺瘤的癌胚抗原水平较低（<23），这表明CEA可区分黏液性囊肿和非黏液性囊肿（p<0.0001）。CA 125在所有恶性囊肿中水平较高，在假囊肿中水平较低，在黏液性囊性肿瘤和浆液性囊腺瘤中水平各异。CA 19.9水平无鉴别意义。囊液淀粉酶和脂肪酶含量各异，但假囊肿中通常较高，囊性肿瘤中较低。淀粉酶同工酶分析有助于区分假囊肿和囊性肿瘤。囊液相对黏度测定显示，89%的黏液性肿瘤相对黏度较高（>血清黏度），所有假囊肿和浆液性囊腺瘤相对黏度较低（<血清黏度）（p<0.01）。囊液细胞学分析在区分假囊肿和浆液性囊腺瘤方面价值有限，但在8个黏液性肿瘤中的7个中提供了有用的诊断信息，并正确分类了5个恶性肿瘤中的3个。作者得出结论，囊液分析可为这些诊断困难的病变提供术前分类。黏度、CEA、CA 125和细胞学的联合检测可可靠地区分恶性囊性肿瘤和潜在的癌前黏液性囊性肿瘤与假囊肿和浆液性囊腺瘤。淀粉酶含量及同工酶分析有助于识别假囊肿。
