摘要目的 探讨胰腺腺泡细胞癌的临床病理学及免疫组织化学特征.方法 回顾解放军总医院病理科2011至2016年间已确诊的胰腺腺泡细胞癌14例的临床资料及组织病理学特征,进行Trypsin、bcl?10及细胞角蛋白(CK)等免疫组织化学EnVision法染色.结果 按第4版WHO消化系统肿瘤诊断标准,14例胰腺腺泡细胞癌中,单纯性腺泡细胞癌9例,混合性导管?腺泡细胞癌3例,混合性神经内分泌?腺泡细胞癌1例,混合性导管?神经内分泌?腺泡细胞癌1例.发生在胰头部8例,胰体尾4例,胰腺沟突1例,十二指肠Vater壶腹异位胰腺1例.诊断时4例已发生邻近器官侵犯,2例发生淋巴结、肝转移.临床病理特征显示肿瘤富于细胞,呈腺泡及实性结构,小叶之间纤维性间质少.分化好的细胞胞质丰富,嗜酸性颗粒状,单个明显的核仁;分化不良的细胞较小,细胞核特征不明显,缺乏嗜酸性颗粒状胞质,易见实性结构.腺泡细胞癌呈现多种分化,表现为导管?腺泡、神经内分泌?腺泡和导管?神经内分泌?腺泡3种形式.免疫组织化学显示肿瘤细胞广谱细胞角蛋白(CKpan)阳性比例14/14,Trypsin阳性比例12/14,bcl?10阳性比例11/14,而 CK7、CK19阴性比例11/14和3/4.14例患者均行手术治疗,TNM分期分别为ⅠA期3例,ⅠB期4例,ⅡA期3例,Ⅲ期3例,Ⅳ期1例.术后随访时间6~58个月,平均无瘤生存时间16个月.结论 腺泡细胞癌是一种罕见的相对惰性的恶性肿瘤,形态学及免疫组织化学具有特征性,正确的诊断对于治疗和判断预后具有重要意义.

abstractsObjective To investigate clinical, pathological and immunohistochemical features of pancreatic acinar cell carcinoma. Methods A retrospective review of surgical and pathological databases between 2011 and 2016 at PLA General Hospital was collected and 14 cases of acinar cell carcinoma(ACC) of the pancreas were identified. EnVision immunohistochemistry was used to detect the expression of Trypsin,bcl?10 and cytokeratin(CK)proteins. Results The patients included nine cases of pure ACC, 3 cases of mixed acinar ductal carcinoma, 1 case of mixed acinar?neuroendocrine carcinoma and acinar?ductal?neuroendocrine carcinoma, respectively. Tumors involved different anatomic locations of the pancreas,including eight involving the head of pancreas, four in the body and tail, one in the uncinate process and one in a heterotopic pancreas. Two patients had lymph node and liver metastases before surgery. Microscopically,the tumor was hypercellular with less fibroblastic proliferation and tumor cells arranged in acinar or solid pattern. The well differentiated tumor cells showed eosinophilic, granular cytoplasm with single prominent nucleoli,while the poorly differentiated tumor cells tended to grow in solid sheets. Immunohistochemically,the tumor cells were positive for pan?cytokeratin(14/14), Trypsin(12/14)and bcl?10(11/14). Stains for CK7 and CK19 were negative(11/14 and 3/4). According to the pTNM staging,there were 7 cases at stageⅠ, 3 at stage ⅡA, 3 at stage Ⅲ and 1 at stage Ⅳ. With average postoperative follow?up of 6-58 months,the median disease?free survival time was 16 months. Conclusions Pancreatic acinar cell carcinoma is a rare and relatively indolent malignant tumor with characteristic histopathological and immunohistochemical features. Accurate pathological diagnosis plays an important role in patients′treatment and evaluation of prognosis.