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导管内乳头状黏液性肿瘤

作者:大江 | 时间:2020-6-19 00:02:33 | 阅读:423| 显示全部楼层
导管内乳头状粘液性肿瘤(IPMN)是一种可能发生在胰管细胞内的肿瘤。 IPMN肿瘤会产生粘液,并且该粘液会形成胰腺囊肿。尽管导管内乳头状粘液性肿瘤是良性肿瘤,但它们可以发展为胰腺癌。因此,IPMN被视为癌前状态。一旦发现导管内乳头状粘液性肿瘤,管理方法包括严密监测和先发性手术。


导管内乳头状粘液性肿瘤的磁共振成像。

内容
1 诊断
2 治疗
3 历史
4 参考

诊断
通过组织病理学,IPMN在光学显微镜下的特征是粘液上皮细胞和胰管内的生长。粘蛋白5AC是有用的免疫组化标记。 !!显微镜检查结果!显微照片!免疫组化标记物特征性遗传改变是KRAS和GNAS的遗传改变。

IPMN的进一步子类型可以通过以下方式之一完成:

大体病理:主导管与分支导管的病变,决定了手术管理
通过光学显微镜和免疫组织化学:胃,肠,胰胆管和溶细胞。

60岁男性胰腺切除远端标本中IPMN类型的组织病理学(通过大体病理学(中心图),显微镜和免疫组织化学检查):切除标本(c)显示MPD中的壁结节由PB型IPMN组成高度不典型增生(腺癌)(a),p53免疫染色(插入)和KRAS突变(G12V)弥散阳性。身体的BD-IPMN内衬着胃粘液样上皮,显示出低乳头状构型,轻度上皮分层,具有相同的KRAS突变(d),相似的胃IPMN组分的增殖依次累及壁结节的底部和壁的壁。周围膨胀的MPD(用红色箭头指示)(b)。尾巴的BD-IPMN内衬平坦的单层胃粘液上皮,缺乏细胞异型性和KRAS突变(e)。

治疗
主动脉IPMN的首选治疗方法是切除,因为其恶性几率约为50%。有时用常规的CT或MRI监测侧支IPMN,但最终将其切除,在这些切除的肿瘤中,恶性率为30%。 IPMN切除无恶性肿瘤后的5年生存率约为80%,恶性肿瘤为85%,但无淋巴结扩散,恶性肿瘤扩散为淋巴结为0%。手术可以包括切除胰头(胰十二指肠切除术),切除胰体和尾巴(远端胰切除术)或很少切除整个胰腺(全胰切除术)。在某些情况下,可以使用微创技术(例如腹腔镜或机器人手术)进行手术。一项使用监视,流行病学和最终结果登记表(SEER)数据的研究表明,在手术期间收获的淋巴结计数增加与侵袭性IPMN患者的存活率更高有关。

历史
1982年,日本癌症研究基金会的大桥和彦(Kazuhiko Ohashi)将IPMN报告为“产生粘蛋白的肿瘤”。

参考
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"Precancerous conditions of the pancreas - Canadian Cancer Society".  Retrieved 5 November 2017.
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"This article is distributed under the terms of the Creative Commons Attribution 4.0 International License "
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