中年女性,上腹痛三周,请诊断!

2019-11-29 不详 影像园

中年女性,上腹痛三周,请诊断!

【所属科室】


【基本资料】

患者,女,33岁

【主诉】

上腹痛三周

【影像图片】



【讨论问题】如何诊断

【讨论】

评论:胰头区类圆形占位,密度不均,边缘不清,其中见低密度液化坏死区,增强后可见环状及斑片状强化,首先考虑胰岛细胞瘤,其次胰头癌。
 
【结果】

病理诊断:无功能胰岛细胞瘤
 
【病例小结】

胰岛细胞瘤为罕见病,人类发病率为1/100万。而无功能胰岛细胞瘤并不代表其不分泌激素及异位激素,只是其产生的激素,不足以导致临床综合征。本病好发于中青年女性,男女之比约1:2.5~3.0,肿瘤多为单发,多发很少见,前者约占99%;良性较恶性多,良性约占65%,恶性约占35%。瘤体往往很大,但患者的一般情况尚好。

【CT表现】

1. 肿瘤较大,肿瘤较功能性胰岛细胞瘤大,在胰内无明显好发部位,90%以上的瘤体直径大于3cm,平均约为8cm,多呈类圆形,边缘较光整,有包膜,可有浅分叶,平扫低密度或等密度,或呈不均质密度,常有坏死、囊变、出血。

2. 肿瘤为富血供,增强扫描动脉期病灶强化较明显,高于正常胰腺实质,而静脉期肿瘤强化程度明显减退。

3. 20%~30%病例出现瘤内钙化,恶性无功能胰岛细胞瘤钙化机率高。

4. 肿瘤呈膨胀性生长,对周围结构只是压迫和推移,一般无浸润血管现象。恶性病变可见胰周淋巴结肿大,以及肝转移等。

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