目的 总结胰腺实性假乳头状瘤（solid-pseudopapillary tumor of pancreas, SPTP）的诊治经验。方法 回顾性分析我院1999年11月至2007年10月期间收治的6例SPTP患者的临床资料。结果 6例均为女性，其中4例为年轻女性； 术前均未确诊； 行胰腺体尾部切除2例，肿瘤局部切除4例，其中2例加脾切除，术后病理报告确诊为SPTP。 术后无严重并发症，随访1～95个月，无复发和转移。结论 SPTP多发于年轻女性，术中冰冻切片对术中处理提供参考，手术切除为首选治疗方法，预后良好。
Objective To know the abnormal expression of the cell cycle-regulated proteins in pancreatic adenocarcinoma and their effect on tumor cell growth. Methods The expression of p16, p21, Rb and p53 protein in 47 cases were investigated by immunohistochemistry with wet autoclave pretreatment for antigen retriaval. Furthermore, tumor growth index were assessed by a novel anti-ki-67 antibody (ki-s5). Results All the expression of p53, p16, p21 and Rb protein were the nuclear stainning. The positive rates of p53, p16, p21 and Rb protein were 55%, 53%, 74% and 98% respectively. There was negative correlation between of p16, p21 or Rb protein expression and ki-67 growth index. No relation of p53 protein stainning and the expression of p21 protein was found. Conclusion In pancreatic adenocarcinoma, the negative expression of p16 protein and p21 protein may play an important role in tumor cell growth, but tumor proliferation caused by abnormality of Rb protein is rare. The expression of p21 protein was not associated with the expression of p53 protein.
ObjectiveTo study the clinicopathologic features, diagnosis and treatment of papillary cystic and solid tumor of the pancreas (PCSTP).MethodsOne case with PCSTP in our hospital and a review of 60 others from the literatures of the People’s Republic of China, a total of 61 cases were analyzed retrospectively.ResultsThe patients (57 women, 4 men) were of mean age 24.6 (range 9~59) years. The main manifestations included abdominal mass (n=52), pain (n=22) and discomfort (n=10). They were distributed in the head (n=29), neck and body (n=2), body (n=1), body and tail (n=5), tail (n=16) and capsule (n=2) of the pancreas. The other 6 cases occurred outside the pancreas. All the patients underwent surgical therapy. The tumors were identified by postoperative histopathologic examination, 7 of which were malignant (11.5%). The total 1, 3, 5year survival rate was 100%, 96.1% and 86.5% respectively.ConclusionIt is difficult to correctly diagnose the PCSTP before operation because PCSTP is often lack of typical clinical manifestations. The correct diagnosis should depend on histopathologic examination.Complete removal of the PCSTP is the most perfect treatment. PCSTP has a good prognosis.
Objective To study the expression and clinic significance of nm23 gene (product of uncleoside ciphosphate kinase) in the pancreatic adenocarcinoma tissues. MethodsSP immunohistochemical method was used to examine the expression of nm23/NDPK in 40 pancreatic adenocarcinoma and 14 normal pancreas tissues.ResultsTwentysix of 40(65%) pancreatic adenocarcinoma showed b immunoreactivity for NDP kinase, whereas 4 of 14 (28.5%) normal pancreatic tissues showed weak immunoreactivity. Significant difference was found between the two groups (P＜0.05). The nm23/NDPK expression levels in pancreatic adenocarcinoma of lower differentiation was higher than those in pancreatic adenocarcinoma of higher differentiation (10/11，90.9%; 2/8, 25%; P＜0.05). Positive staining was associated with higher incidence of lymph node metastasis (10/14, 71.4%) than negative staining (6/19,31.5%, P＜0.05). These results suggested that nm23/NDPK expression was positively associated with lymph node metastasis and aggressiveness. They also suggested that nm23/NDPK expression had negative correlation with the extent of histologic differentiation. Conclusion nm23/NDPK can serve as a marker for malignant potentiality and indicate the prognosis of pancreatic adenocarcinoma.
目的 探讨胰腺恶性纤维组织细胞瘤的诊断及治疗。方法 对兰州大学第一医院收治的1例胰腺恶性纤维组织细胞瘤患者，结合国、内外文献对其临床特点，影像学、病理学及免疫组化特征、治疗和预后进行分析。结果 行胰腺肿瘤切除，术后医用直线加速器采取三维适形精确放疗，随访9个月，未见肿瘤复发。结论 胰腺恶性纤维组织细胞瘤恶性度高，易复发、转移，生存率低，诊断主要依靠病理和免疫组化检查。外科手术联合放射治疗可延长生存时间和延缓肿瘤的复发。
ObjectiveTo investigate the expression of cyclooxygenase-2 (COX-2) and vascular endothelial growth factor (VEGF) in human pancreatic adenocarcinoma and their correlation with clinicobiological behavior.MethodsThe expression of COX-2 and VEGF in 51 cases of human pancreatic ductal adenocarcinoma were detected with immunohistochemistry of Envision.ResultsExpression of COX-2 and VEGF in pancreatic ductal adenocarcinoma were 74.5% and 68.6%, respectively; no expression of COX-2 and VEGF in adjacent normal tissue was detected. Both COX-2 and VEGF expression in clinical stage Ⅲ-Ⅳ were much higher than those in clinical stage Ⅰ-Ⅱ, and also higher in positive group of lymph node metastasis than in negative group as well (Plt;0.05). None of them had relation with histological grades, age, sex, tumor size and location. The expression of COX-2 was closely correlated with VEGF (r=0.411, Plt;0.01).ConclusionCOX-2 and VEGF may play a pivotal role in tumorigenesis and tumor progression in pancreatic cancer, they may provide new targets for therapy of pancreatic cancer.
Objective To discuss the methods of diagnosis and treatment of cystic neoplasms of pancreas. Methods Demographic data, clinical manifestations, diagnostic exams, surgical procedures, pathological diagnosis, postoperative complications, and follow-up data of 29 patients with cystic neoplasms of pancreas were analyzed retrospectively. Results There were 8 （28%） serous cystic tumors （SCN）, 12 （41%） mucinous cystic tumors （MCN）, 3 （10%） intraductal papillary mucinous tumors （IPMN）, and 6 （21%） solid pseudopapillary tumors （SPT）. Eight cases of SCN, 7 cases of MCN, 1 case of IPMN, and 5 cases of SPT were all benign. The ages of the patients were from 15 to 78 years〔average, （49±17）years〕and all tumors were more common in female （76%, 22/29）. Twenty-three cases of 29 patients were performed operations, 22 cases were underwent surgical resection, and 1 case was performed exploration and biopsy. There was no surgery-related death. The rest 6 cases were not performed operation. Twenty-one cases followed-up for 6 months to 8 years 〔average, （2.7±2.3） years〕, 8 cases didn’t followed-up. Sixteen cases with surgical resection had no recurrence during follow-up period, 1 case performed exploration and biopsy died in 1 year after operation, and 4 cases of SCN without surgery didn’t deteriorate. Conclusions The most common cystic neoplasms of pancreas are mucinous and serous cysts. These tumors are more frequent in female. Although almost all serous cysts are benign, 42% of mucinous cysts are malignant. Misdiagnosis may delay appropriate treatment and increase mortality. The resection rate of pancreatic cystic tumor is high, and the prognosis is good after radical resection.
Objective To investigate the CT and MR imaging manifestation of rare pancreatic tumors in order to deepen the understanding of their imaging characteristics and improve the diagnostic accuracy. Methods Clinical and image date of 34 cases with rare pancreatic tumors proved by surgery and histopathologically were analyzed retrospectively. Including neuroendocrine tumors of the pancreas (NETP,n=13), solid-pseudopapillary tumors of pancreas (SPTP,n=10), intraductal papillary mucinous neoplasms (IPMN,n=2), serous cystadenoma (SCA,n=7), and mucinous cystadenoma (MCA,n=2). Examined by CT in 19 cases, by MRI in 11 cases, examined by CT and MRI at the same time in 4 cases. The characterized imaging features of each kind of tumors were analyzed emphatically. Results Of the 13 cases of NETP, solid lesions in 6 cases, predominantly soild in 4 cases, predominantly cystic in 3 cases. Homogenous enhancement in 6 cases, heterogeneous enhancement in 7cases, the soild constituent of all cases were showed moderate to marked enhancement. Of the 10 cases of SPTP, predominantly soild in 2 cases, soild and cystic in 5 cases, predominantly cystic in 3 cases. The solid part of 10 cases presented as gradually enhancement, 2 cases appeared hemorrhage, 1 case appeared stippled calcification. Of the 2 cases of IPMN, both of them were combined type, showed multilocular cystic tumors due to the dilated of the pancreatic duct. Of the 7 cases of SCA, microcystic partten in 3 cases and single cyst partten in 4 cases, showed unilocular or multilocular cystic with clear boundary. The 2 cases of MCA, showed unilocular cystic with clear boundary. Conclusion Different histological types of pancreatic rare tumor appeared different kinds of imaging characteristic, we may improve the diagnostic accuracy by analyzing their features.
Objective To investigate the application progress of mixed reality (MR) technology in hepatobiliary and pancreatic fields. Method The relevant literatures on the application of MR technology of the hepatobiliary and pancreatic field in recent years at home and abroad were reviewed. Results MR technology had been widely used in the hepatobiliary and pancreatic field, including preoperative diagnosis and evaluation, surgical plan formulation, doctor-patient communication, intraoperative navigation precision surgery, teaching practice and many other aspects, which had the advantages of shortening the operation time, reducing the difficulty of surgery and improving the success rate of surgery. To some extent, it had promoted the innovation of clinical diagnosis and treatment in the field of liver, gallbladder and pancreas. Conclusions The application and development of MR related techniques are of great significance to the operation and teaching in the hepatobiliary and pancreatic field. With the development and progress of MR technology and modern medicine, MR technology will give full play to its advantages in intelligent real-time navigation hepatobiliary and pancreatic surgery system and promote the further development of hepatobiliary and pancreatic surgery.
ObjectiveTo summarize of clinical application and progress of duodenum-preserving pancreatic head resection (DPPHR).MethodThe relevant literatures published recently at domestic and abroad about the clinical application and progress of DPPHR were collected and reviewed.ResultsFor the benign lesions, low-grade malignancies and borderline tumors of the head of pancreas, the DPPHR could achieve the same expected therapeutic effect as the classical pancreatoduodenectomy. The DPPHR could reserve the continuity of stomach and duodenum while resecting lesions and improve the symptoms of patients, reduce the reconstruction of digestive tract and the resection of pancreas and surrounding tissues as much as possible, and retain the pancreas-intestinal axis, which was more in line with the physiology of human beings.ConclusionsAt present, DPPHR is worthy of further development and promotion in department of pancreas surgery, but current studies only focus on occurrence of short-term complications after operation. Because patients with benign diseases of pancreatic head have better prognosis and longer survival time after operation, we should pay attention to the long-term complications such as diarrhea, anemia and reflux cholangitis. More clinical studies need in future to be demonstrated superiority of DPPHR in clinical efficacy and to evaluate occurrence of long-term complications and their impact on quality of life of patients with DPPHR by comprehensive analysis of multiple evaluation indicators.