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摘要:
目的 分析胰腺淋巴上皮囊肿(pancreatic lymphoepithelial cyst，PLEC)的临床诊治特点，为提高其诊疗水平提供借鉴和参考。 方法 回顾性分析2015年1月至2019年12月在北京协和医院基本外科行手术治疗并最终确诊为PLEC的患者临床资料，分析其临床表现、影像学特征及治疗效果。 结果 共7例患者确诊为PLEC，年龄31~65岁，其中男性4例，女性3例；5例患者肿物位于胰体尾部，1例位于胰颈部，1例位于胰头部；2例患者血清CA19-9水平增高；3例患者术后出现胰瘘导致腹腔引流管拔除延迟；1例随访中出现体重下降。 结论 PLEC是一种罕见的胰腺囊性病变，临床表现不典型，术前诊断较为困难，手术可完整切除，预后良好；无症状者可考虑保守治疗和随访观察。 Abstract:Objective The aim of this study was to investigate the clinical characteristics of pancreatic lymphoepithelial cyst (PLEC), a rare cystic lesion in the pancreas. Methods The clinical data of patients with PLEC who underwent pancreatectomy from 2016 to 2019 in Peking Union Medical College Hospital were analyzed retrospectively. The clinical presentations and imaging features were summarized. Results A total of 7 patients with PLEC were included in this study, including 4 males and 3 females. The average age was 49 years old. One patient suffered from abdominal distension and the other 6 showed no symptom. A unique round lesion in the pancreas was found in all cases with cross-section scanning. Five lesions were located in pancreatic body and tail, and two were found in pancreatic head and neck. Serum CA19-9 levels were above normal upper limit in two patients. 18F-FDG PET/CT was performed in two patients, which showed high intake in part of the cyst wall in one patient. The complications with pancreatectomy in this cohort were pancreatic fistulae in 3 patients and low body weight in one patient. No sign of recurrence was found during a median follow-up of 17 months. Conclusions PLEC is a rare benign cystic lesion in the pancreas. The preoperative differential diagnosis was quite difficult with imaging examination and clinical presentations. A comprehensive diagnosis strategy with endoscopic ultrasonography aspiration biopsy may help for preoperative diagnosis. Asymptomatic patients can be considered for observation and follow-up. -
Key words:
- pancreatic lymphoepithelial cyst /
- diagnosis /
- surgery /
- rare disease
作者贡献:胡亚负责文章撰写；常晓燕负责病理诊断回顾；薛华丹负责影像学分析；戴梦华、张太平、廖泉、王维斌、赵玉沛负责手术治疗。利益冲突 无 -
图 1 胰腺淋巴上皮囊肿患者典型影像及病理图片
A.MRI胰胆管造影显示囊肿与胰管不相通，胰管无扩张；B.一例PET/CT显示囊壁局部SUVmax为7.5，考虑恶性病变；C.术后病理HE染色可见淋巴组织构成的囊壁内覆鳞状上皮，囊肿内含有角蛋白及细胞碎片
PET/CT、SUVmax:同表 1表 1 7例胰腺淋巴上皮囊肿患者的临床特征
编号 性别 年龄(岁) 症状 既往史 肿瘤部位 PET/CT 肿瘤最大直径(cm) 血浆CEA(ng/mL) 血浆CA19-9(U/mL) 手术方式 预后 随访时间(月) 1 男 51 无 高血压 胰体尾 无 4.6 无 无 胰体尾切除术 胰瘘 44 2 女 31 无 无 胰尾 无 4.0 1.02 15.8 机器人辅助胰体尾切除术 血小板计数增高 63 3 男 59 无 高血压、吸烟、饮酒 胰体尾 无 5.5 3.97 26.6 腹腔镜胰体尾切除术 胰瘘 22 4 女 39 无 无 胰尾 考虑良性 5.5 1.21 19.2 腹腔镜胰体尾切除术 无特殊 17 5 男 65 无 高血压、外伤、吸烟、饮酒 胰颈 无 2.5 1.35 30 肿物摘除术 无特殊 17 6 男 54 无 吸烟 胰头 SUVmax为7.5，考虑胰腺囊肿恶变 7.5 2.5 1815 保留幽门胰十二指肠切除术 体重下降 16 7 女 47 腹胀 子宫肌瘤手术 胰尾 无 2.7 1.2 230.7 腹腔镜胰体尾切除术 胰瘘 11 PET/CT:正电子发射断层显像/计算机体层成像；CEA:癌胚抗原；SUVmax：最大标准摄取值 
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