胰腺导管内乳头状黏液性肿瘤的病理诊断进展

doi:10.16139/j.1007-9610.2024.01.11

摘要/Abstract

摘要：

胰腺导管内乳头状黏液性肿瘤（intraductal papillary mucinous neoplasm, IPMN）是胰腺导管腺癌重要的癌前病变。IPMN诊疗决策的制定首先基于对IPMN相关病理学的深刻理解。本文围绕IPMN宏观检查、微观检查、分子检测及鉴别诊断四个方面进行系统的文献综述。本综述详细阐述了IPMN大体类型分类、组织学分级与分化亚型、IPMN伴浸润性癌的组成模式和组织学类型、IPMN分子研究的新进展以及重要的鉴别诊断等。该分析肯定IPMN特殊的异质性和异时性的特点，为寻找新的方法帮助临床医师制定适宜的诊疗方案奠定基础。

关键词: 胰腺导管内乳头状黏液性肿瘤, 癌前病变, 病理诊断, 鉴别诊断

Abstract:

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is an important precancerous lesion to pancreatic ductal adenocarcinoma. Clinical decisions in the diagnosis and treatment of IPMN are foremost based on a profound understanding of the related pathology of IPMN. Systematic literature reviews were conducted around four aspects of macroscopic examination, microscopic examination, molecular detection and differential diagnosis of IPMN. This review provided updated perspectives on gross types, histological grades and differentiation subtypes, the composition pattern and histological classification of IPMN with invasive carcinoma, the molecular research of IPMN and important differential diagnosis. This analysis confirms the heterogeneity and heterochronous in IPMN, laying the foundation for finding new method to help clinicians developing appropriate diagnosis and treatment plans.

Key words: Intraductal papillary mucinous neoplasm(IPMN) of the pancreas, Precancerous lesion, Pathological diagnosis, Differential diagnosis

中图分类号:

R735.9

王婷, 王朝夫, 袁菲. 胰腺导管内乳头状黏液性肿瘤的病理诊断进展[J]. 外科理论与实践, 2024, 29(01): 67-73.

WANG Ting, WANG Chaofu, YUAN Fei. Progress in pathological diagnosis of intraductal papillary mucinous neoplasm of the pancreas[J]. Journal of Surgery Concepts & Practice, 2024, 29(01): 67-73.

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异型增生级别	组织形态	细胞形态	核分裂象
低	肿瘤细胞排列成单层或具有轴心的乳头状结构	细胞轻-中度异型，细胞核位于基底部或呈假复层排列	罕见或偶见
高	肿瘤细胞排列成复杂分支乳头、筛孔状、出芽	细胞高度异型，细胞核多形性，缺乏极性	多见或靠近管腔表面

	IPMN	PanIN	MCN	ITPN	IOPN
组织学特征
与胰管关系	相通	相通	不相通	相通	相通
附壁结节	有或无	无	无	有	有
上皮异型性	低级别、高级别	低级别、高级别	低级别、高级别	高级别	高级别
卵巢样间质	无	无	有	无	无
免疫组织化学特征
CK7/CK8/CK18/CK19	+	+	+	+	+
CK20/MUC2/CDX2	肠型+	-	-	-	杯状细胞+
MUC1	胰胆管型+	+	-/+^a)	+	+
MUC5AC	+	+	+	-	+
MUC6	可+，可-	低级别+	-	+	+
其他特殊标记	无	无	有^b)	无	有^c)