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目的探讨累及全胰腺的导管内腺泡细胞癌的临床及病理特点。方法通过组织病理学和免疫组化染色观察胰腺导管内腺泡细胞癌的特征,总结临床特点并复习文献。结果患者女性,47岁。临床特点及影像学观察类似胰腺导管内肿瘤。镜下整个胰腺导管内可见成片肿瘤细胞被纤细的纤维组织分隔成多结节状,有出血和坏死,未见黏液。肿瘤细胞呈实性片状,细胞大小较一致,核分裂多少不等,细胞核居中,核仁清楚。肿瘤沿胰腺导管蔓延到胆总管及周围的小导管内,局灶可见浸润,浸润深度约0.2 cm。免疫组化显示bcl-10和胃蛋白酶(+),AAT、AACT和CK19(+),神经内分泌抗体(-)。结论腺泡细胞癌发生在胰腺导管内罕见,累及全胰腺更为少见。临床及影像学检查难以与导管内肿瘤鉴别,组织学形态与经典的腺泡细胞癌相同,预后明显好于经典腺泡细胞癌。
Objective To investigate the clinical and pathological features of intraductal acinar cell carcinoma involving the pancreas. Methods The histopathology and immunohistochemistry were used to observe the characteristics of pancreatic ductal acinar cell carcinoma and to summarize the clinical features and review the literature. Results Patients Female, 47 years old. Clinical features and imaging findings similar to pancreatic ductal tumors. Microscopic pancreatic duct can be seen as a piece of tumor cells were slender fibrous tissue separated into multiple nodular, with bleeding and necrosis, no mucus. Tumor cells were solid flake, the cell size more consistent, how many different nuclear fission, the nucleus is middle, clear nucleolus. Tumor spread along the pancreatic duct to the common duct and around the small duct, infiltration of focal visible infiltration depth of about 0.2 cm. Immunohistochemistry showed bcl-10 and pepsin (+), AAT, AACT and CK19 (+), neuroendocrine antibodies (-). Conclusions Acinar cell carcinoma occurs rarely in the pancreatic duct and is more uncommon in the pancreas. Clinical and imaging studies are difficult to identify with intraductal tumors, histological morphology and the same classic acinar cell carcinoma, the prognosis was significantly better than the classic acinar cell carcinoma.