胰腺實(shí)性假乳頭狀瘤ppt課件

1、Fudan Cancer Center陳其文Solid-Pseudopapillary Tumor of Pancreas(SPTP). 1.Franz described this tumor in 1959 as a “papillary tumor of the pancreas, benign or malignant 2.1996,WHO in its classification of exocrine pancreatic tumors, recognized them as “solid pseudopapillary tumors of the pancreas. 3. Lo

2、w potentially malignant, about 10% have malignant behavior 4. Capsule intact or not has a relation to the malignant behavior and recurrence after surgery Franz VK. Tumors of the pancreas. In: Atlas of tumor pathology: fasc 2728, ser 7. Washington, DC: Armed Forces Institute of Pathology, 1959:3233Pa

3、pavramidis T, Papavramidis S. Solid pseudopapillary tumors of the pancreas: review of 718 patients reported in English literature. J Am Coll Surg, 2005,200(6):965-972.1.Unusual primary tumor of the pancreas account for 9% of the cystic tumor of pancreas and 1%-2.25% of the exocrine pancreatic tumors

4、2.With a low potential for malignancy3. Unknown cell origin 4.Seen mostly in young women, may be accelerated by pregnancy the male to female ratio is 1:9.5 .Klimstra DS, Wenig BM, Heffess CS. Solidpseudopapillary tumor of the pancreas: a typically cystic carcinoma of low malignant potential. Semin D

5、iagn Pathol 2000; 17:6680Features.Pancreatic Head :39.8%Tail :24.1%Body and Tail :19.5% Body :11.2%Neck :3.6%Extrapancreatic SPT was found in 1.8% patients.Metastasis:Liver metastasis is seen in a few cases, and rare cases of lymph node metastasis, peritoneal spread, and multiplicity have been repor

6、tedExtracapsular Invasion:SPTP infrequently invades a capsule and the surrounding structures, mainly the spleen, portal vein, and duodenum.Involved Organs:Portal Vein/Spleenic Vein/Superior Mesenteric Vein:11Omentum or Peritoneum:7Duodenum:7Liver :6Spleen:4 Stomach:3Colon:2Diaphragmatic Muscle:1Left

7、 Kidney :1Peng FY, Zhen HH, Xin BW, et al. Solid pseudopapillary tumor od the pancreas: A review of 553 cases in Chinese literature. World Journal of Gastroenterology. 2021,16(10):1209-1214.Typical SPTP: characterized by a well-encapsulated mass with varying amounts of intratumoral hemorrhage Atypic

8、al SPTP: metastasis ductal obstruction parenchymal and extracapsular invasion intratumoral calcification occurrence in a male patient. in Chinese Literature in English Literature .Pathologic examination reveals that solid pseudopapillary tumor is usually a large, encapsulated mass composed of a mixt

9、ure of cystic, solid, and hemorrhagic components.1.Mostly within the normal level2.Very few increase, just slightly3.The increased level of tumor makers does not mean the tumor is malignant or bad prognosis.Ultrasonographically, the tumors are well-defined hypoechoic solid masses, solid masses conta

10、ining cystic areas, cystic mass, and semicircularly calcified lesions.1.Both a capsule and intratumoral hemorrhage are important clues to the diagnosis because these features are rarely found in other pancreatic neoplasms2.Majority are round or oval shaped.The lesion can be totally solid, solid cyst

11、ic and totally cystic.And solid cystic consists the most of the lesion Cantisani V, Mortele KJ, Levy A, et al. MR imaging features of solid pseudopapillary tumor of the pancreas in adult and pediatric patients. AJR 2003;181:395401. 3. Smaller solid pseudopapillary tumors are less sharply circumscrib

12、ed and often appear unencapsulated.Cantisani V, Mortele KJ, Levy A, et al. MR imaging features of solid pseudopapillary tumor of the pancreas in adult and pediatric patients. AJR 2003;181:395401. 44-year-old woman with pancreatic mass found on sonography. A, Radiograph shows curvilinear calcificatio

13、n (arrow) in left upper quadrant of abdomen. B, Transverse sonogram shows dense peripheral rim calcification with posterior acoustic shadowing (arrow).19-year-old woman with palpable abdominal mass of solid pseudopapillary tumor. Contrast-enhanced CT scan shows wellencapsulated heterogeneous mass(ar

14、row) in tail of pancreas.Choi BI, Kim KW, Han MC, Kim YI, Kim CW. Solid and papillary epithelial neoplasms of the pancreas:CT findings. Radiology 1988; 166:413416B, CT scan shows cystic mass (arrow) with focal solid portion in liver.42-year-old woman with pancreatic mass found incidentally on imagin

15、g.A, Axial CT scan of pancreas shows encapsulated mass with peripheral calcification and focal extracapsular extension (arrow).B, T1-weighted gradient-echo image of pancreas shows heterogeneous mass (arrow).42-year-old woman with pancreatic mass found incidentally on imaging. Photograph of gross pat

16、hologic specimen shows focal pericapsular extension (arrow).58-year-old woman with pancreatic mass on sonography. Coronal reformatted CT scan shows dense, thick, peripheral calcification (arrow).44-year-old woman with pancreatic mass found on sonography. Unenhanced CT scan shows peripheral curviline

17、ar calcification (thin arrow) and internal hemorrhage (wide arrow).Smaller solid pseudopapillary tumors are less sharply circumscribed and often appear unencapsulated.1.Percutaneous fine-needle cytology of the cystic wall can be useful and can influence subsequent management.2. Endoscopic ultrasonog

18、raphy scan with fine-needle aspiration biopsy becomes more popular, and can be useful in identifying the tumor.趙玉沛，等. 胰腺實(shí)性假乳頭狀瘤的診斷和治療. 中華消化外科雜志，2021，76：411.Surgery is the only curative way to treat SPTP.97.3% of the patients can receive surgery. 96.4% patients have disease free survival after surger

19、y .1.The presence of metastasis in the SPT patients is NOT a contraindication for surgery。In these cases with metastasis, complete resection of both primary tumor and metastasis lesions, if possible, is proposed.2. Invasion to the portal vein or superior mesenteric artery should NOT be included as a

20、 criterion for nonresectability of these pancreatic neoplasms. 1.Extensive lymphatic dissection or more radical local approaches are not indicated. 2.For the metastases, there is also general consensus that surgical debulking should be performed. 3.Specifically, when liver metastases were present, o

21、perative excisions were used in most patientsShimizu M, Matsumoto T, Hirokawa M, et al. Solidpseudopapillary carcinoma of the pancreas. Pathol Int 1999;49:231234.Matsunou H, Konishi F. Papillary-cystic neoplasm of the pancreas: a clinicopathologic study concerning the tumor aging andmalignancy of ni

22、ne cases. Cancer 1990;65:283291.1.Chemotherapy based on Gemcitabine is successful in some patients2.TACE in patients with multiple hepatic metastases seems to be of value3.Radiotherapy has been suggested in cases of unresectable SPTs because they are radiosensitive.Maffuz A, Bustamante Fde T, Silva

23、JA, et al. Preoperative gemcitabine for unresectable, solid pseudopapillary tmor of the pancreas. Lancet Oncol, 2005,6(3):185-186.Fried P, Cooper J, Balthazar E, et al. A role for radiotherapy in the treatment of solid and papillary neoplasms of the pancreas. Cancer, 1985,56(12):2783-2785. As report

24、ed so far, there have been 4 articles regarding spontaneous regression of SPTP and the patients were all pediatric patients.1. Nakahara K, Kobayashi G, Fujita N, Noda Y, Ito K, Horaguchi J, et al. Solid-pseudopapillary tumor of the pancreas showing a remarkable reduction in size over the 10-year fol

25、low-up period. Intern Med. 2021;47:13351339. 2. Suzuki M, Shimizu T, Minowa K, Ikuse T, Baba Y, Ohtsuka Y. Spontaneous shrinkage of a solid pseudopapillary tumor of the pancreas: CT findings. Pediatr Int. 2021;52:335336. 3. Hachiya M, Hachiya Y, Mitsui K, Tsukimoto I, Watanabe K, Fujisawa T. Solid, cystic and vanishing tumors of the pancreas. Clin Imaging. 2003;27:106108. 4.Hyun Jung Yoon,Jae Hoon Lim. Solid Pseudopapillary Tumor of the Pancreas with Hepatic Metastasis: Spontaneous Regression Over 10-Year Follow-Up Period Korean J Radiol. 2021 Sep-Oct; 13(5): 648651.1.In general, the progn