胰腺导管内乳头状瘤.ppt
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1、胰腺导管内乳头状黏液肿瘤 (Intraductal papillary mucinous tumor),北大医院放射科 程晓悦,Patient, female, 79-years old,with tumors in the body of the pancreas founded by the Ultrasound。 CT shows that: Pancreatic atrophy; there were multiple round hypo-dense lesions in the neck and body of the pancreas,with clear boundaries
2、and no enhancement in the enhanced CT scan; Some lesions had a little strip separators and parts of the lesions were close to the main pancreatic duct; The pancreatic duct was dilated.,定义,胰腺导管内乳头状黏液肿瘤(intraductal papillary mucinous tumor,IPMT)是一种特殊的胰腺囊腺瘤,可分泌大量黏液导致主胰管全程扩张,十二指肠乳头部开口由于黏液流过而扩大。 相对少见的胰腺肿
3、瘤 。1982年由Ohashi首先报道,此后陆续有一些报道,但对该病命名不同,如产黏液 癌、导管内癌、导管产黏液肿瘤等。1990年WHO将其统一称为IPMN( intraductal papillary mucinous neoplasms )。,特点,IPMT多见于60岁一70岁老年人,男性多于女性,而临床症状缺乏特异性,主要表现为反复上腹痛、乏力、纳差、消瘦及慢性胰腺炎、2型糖尿病等。 特点: 1、胰管内大量黏液潴留; 2、乏特乳头部开口由于黏液流过而扩大; 3、主要在主胰管发展和播散; 4、很少有浸润的倾向; 5、手术切除率高及预后良好等特点。,病理,IPMT的基本病理改变是胰管内分泌粘
4、蛋白的上皮细胞乳头状增生,分泌大量黏液样物质并潴留于腺管内造成胰管扩张。 组织学上将其分为导管内乳头状黏液瘤、交界性和导管内乳头状黏液癌。 根据肿瘤发生部位,通常把IPMT分为3型: 主胰管型,肿瘤存在于主胰管并其扩张; 分支胰管型,肿瘤位于分支胰管内; 混合型,肿瘤既存在与主胰管又存在于分支胰管。,CT scan of the individual D: presence of a 20 mm BD-IPMN in the body of the pancreas (white arrow).,Main-duct intraductal papillary mucinous tumor (I
5、PMT) with markedly dilated pancreatic duct with papillary projections that enhance on contrast-enhanced CT,MRCP : a cystic lesion in the uncinate process of the pancreas (asterisk) and a communicating branch duct (arrow) between the cyst and the normal caliber main pancreatic duct. These findings ar
6、e characteristic of a branch duct intraductal papillary mucinous neoplasm and this lesion has been stable on follow up MRCP examinations for 3 years.,ERCP shows opacification of the cystic lesion and the focally dilated main pancreatic duct near the cystic lesion.,影像表现,USCTMRIERCPMRCP。 MRI在其分型方面优于CT
7、。 IPMT影像上主要表现为单房或多房囊性肿瘤,常伴有分隔及壁结节;增强扫描可见分隔及壁结节轻-中度强化。 分支管型好发于胰腺钩突,病变呈分叶状或葡萄状由多个直径12 cm的小囊聚合而成。少数也可融合为单一较大囊性改变,其内伴有索条状分隔。 主胰管及分支胰管不同程度的扩张,在CT重建及MRCP中,可清晰显示病变与扩张腺管的关系,直接显示病变与扩张的胰管相通有利于本病的诊断与鉴别诊断。 此外,IPMT常伴有胰腺的萎缩。,C, Helical CT scan shows communication (straight arrow) between dilated main pancreatic d
8、uct (curved arrow) and cystic lesion (arrowhead). D, Histologic specimen shows communication (straight arrow) between main pancreatic duct (curved arrow ) and cystic lesion (arrowhead) covered by papillary epithelium smaller than 1 mm. (H and E, 1),1. Natural history (1) Median age 6168 years (2) Pa
9、tients with malignant IPMNs are about 5 years older as compared with those with benign IPMNs 2. Clinical symptoms (1) Obstructive jaundice(2) Epigastric pain(3) Weight loss(4) Diabetes 3. Imaging 1) The main duct and combined types of IPMNs have a higher risk of associated alignancy as compared with
10、 the branch-duct type 2) Marked dilatation of the main pancreatic duct is associated with malignancy in IPMNs 3) Presence of thickening mural, large nodules or a solid mass is suggestive of malignancy in IPMNs 4) IPMNs with common bile duct obstruction may indicate the occurrence of invasive cancer
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- 胰腺 导管 乳头状
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