这种肿瘤多见于女性 常因上腹部隐痛或体检发现

2017-08-02 郭启勇 中国影像好医生病例集

60岁女性,腹部包块2个月余。无恶心、腹胀及疼痛不适。腹部超声示腹膜后混合性包块,与胰尾分界不清。CT动态增强和病理结合,揭开这一多见于女性的肿瘤的“面纱”。

60岁女性,腹部包块2个月余。无恶心、腹胀及疼痛不适。腹部超声示腹膜后混合性包块,与胰尾分界不清。CT动态增强和病理结合,揭开这一多见于女性的肿瘤的“面纱”。

1.临床资料

病例4-1-35,女性,60岁,腹部包块2个月余。无恶心、腹胀及疼痛不适。腹部超声示腹膜后混合性包块,与胰尾分界不清。

2.影像所见

病例4-1-35:CT动态增强。



图4-1-35a~c,CT增强扫描见左腹部有一类圆形肿块,边界较清,与胰腺分界不清。图4-1-35a动脉期肿块实性部分明显强化,内可见无强化囊变坏死区。图4-1-35b、c门脉期及平衡期示肿瘤强化程度减低

3.病理结果

病例4-1-35:病理结果。



图4-1-35d,病理诊断:胰腺无功能性神经内分泌肿瘤(见文后彩图)

4.诊断分析

(1)胰腺无功能性神经内分泌肿瘤概述:

多见于女性,常因上腹部隐痛或体检发现。肿瘤多为囊实性,增强扫描实性部分呈明显强化;确诊依靠病理检查及免疫组织化学检查。

(2)胰腺无功能性神经内分泌肿瘤影像特征

影像学上肿瘤通常呈外生性生长,较大,常见完整包膜,一般无胰管梗阻表现,可出现淋巴结转移和肝转移。

1)CT表现:

平扫常呈不均匀低密度,其内常见囊变坏死,可见钙化。增强扫描肿瘤实性部分多明显强化,囊变坏死区不强化。

2)MRI表现:

T1WI呈不均匀的低及稍低信号,T2WI呈不均匀较高信号,增强扫描所见类似CT。

(3)胰腺无功能性神经内分泌肿瘤鉴别诊断

1)胰腺实性假乳头状瘤:

好发于年轻女性,临床症状轻微或偶然发现,肿块通常较大且境界清楚,多呈囊实性改变,实性部分呈渐进强化,可伴有钙化及出血表现,一般不伴有胰管及胆总管扩张。

2)胰腺囊腺癌:

当胰腺无功能性神经内分泌肿瘤(NFNTP)明显囊变时,需与胰腺囊腺癌鉴别,后者一般囊壁厚薄不一,多为大单囊,少数呈多囊,囊内可见粗细不均的分隔,并可见壁结节,增强后囊壁、分隔及壁结节可轻度强化。


为乏血供肿瘤。平扫常呈等密度,T1WI信号强度低于正常胰腺,T2WI信号强度稍高于肿块,坏死灶则更高;增强扫描强化不明显,呈相对低密度或低信号,并有一定程度的延迟强化,易引起胰管、胆总管扩张,可伴有远端胰腺萎缩或潴留囊肿,肿瘤多边界不清,易向胰外侵犯,致胰周脂肪和血管受侵,可伴有淋巴结转移和肝转移,一般鉴别诊断不难。

5.诊断

病例4-1-35,胰腺无功能性神经内分泌肿瘤。

来源:《中国影像好医生病例集》

作者:郭启勇

参编:宋彬 卢再鸣 丁莹莹 王梓 王光彬

页码:178-180

出版:人民卫生出版社

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