Analysis Of Clinicopathologic Features And Treatment Of Benign Or Low-grade Malignant Neoplasms Of The Pancreas

BackgroundPancreas both has internal and external secretion function of the organ,And pancreatic benign tumors can be classified pancreatic internal secretion benign tumors and pancreatic external secretion benign tumors.Many of the pancreatic benign tumors are considered as the benign diseases without malignant tendency,while some of them are verified that may become malignant tumors later.For example,most of the pancreatic solid pseudopapillary tumors(SPT)were classified as one kind of the benign tumors before,however,all SPT are considered as low-grade malignant in WHO new category of the digestive system tumors in 2010.The pancreatic serous cystic neoplasms(SCN)are generally considered as benign tumors,so most scholars suggest conservative treatment for this disease.In the clinical,pancreatic benign Tumors mainly include: serous cystic neoplasm、 acinar cell adenoma 、 mature teratoma、cystic lymphangioma、schwannoma、hemangioma and so on.Pancreatic low-grade malignant tumors mainly include: well-differentiated PNEN 、 SPT 、mucinous cystic neoplasms(MCN)、Intraductal papillary mucinous neoplasms(IPMN)and so on.And SPT 、 SCN 、 MCN 、 IPMN are included in pancreatic cystic neoplasms(PCNs).The overall incidence of pancreatic benign or low-grade malignant tumors is low,and most of them have no obvious symptoms,with lacking of special diagnostic methods,which easily are misdiagnosed,and then may miss the best chance of diagnosis and treatment,and even endanger the lives of the patients.With the improvement of modern examination method,more and more pancreatic benign or low-grade malignant tumors have also been found.Due to inexperience in the diagnosis and treatment of these diseases,so it is necessary to raise awareness,pay more attention to the diagnosis and treatment of pancreatic benign or low-grade malignant tumors.ObjectiveTo investigate the clinical manifestation,pathological characteristics,diagnosis and treatment measures and prognosis of pancreatic benign or low-grade malignant tumors and provide reference for clinical diagnosis and treatment of the disease.MethodsClinical data for 127 pancreatic benign or low-grade malignant tumors patients admitted to The First Affiliated Hospital of Zhengzhou University from August 2010 to December 2015 were collected.All cases were confirmed by pathologists for pancreatic benign or low-grade malignant tumors using histopathologic diagnosis method.Analyze retrospectively 127 patients the differences in terms of gender,age,clinical manifestation,physical examination,laboratory examination,pathological characteristics,immunohistochemistry,imaging examination,operation method,postoperative complications and prognosis respectively,and summarize their clinical pathological characteristics,treatment and prognosis.Data were analyzed by SPSS21.0 statistical software.The measurement data were measured by mean ± standard deviation,the difference of two groups were compared by the t test;Difference of enumeration data was compared with chi-square test and count data by using Fisher accurate inspection.Significant differences for P<0.05,difference was not statistically significant for P>0.05.Results127 patients of pancreatic benign or low-grade malignant tumors was 10~79(42.6±16.3)years old,and the female-to-male ratio was 1.82.The most common type was pancreatic neuroendocrine neoplasm(PNEN,55%),followed by pancreatic solid pseudopapillary tumor(SPT,26%).Clinical presentation included abdominal pain in 32% patients,22% patients were asymptomatic,Whipple triad was found in all 41 insulinomas.The detection rate of Ultrasond,CT,MRI for tumor was respectively 73%,93%,92.3%,and CT detected 7 cases of metastatic lesions(7/8).The tumors are usually single lesions,and most of the tumors were located in pancreatic body and tail(46.5%),then in pancreatic head(33.1%).The diameter of tumors were 4.25± 2.93 cm(range 0.2~12 cm).As to the immunohistochemical markers,the difference of CK,Syn,CgA,CD56,CD10,Vimentin,AAT in SPT and PNEN expression was statistically significant(P < 0.05),the difference of NSE,PR,beta Catenin,CD34 in SPT and PNEN expression was not statistically significant(P > 0.05).116 patients were treated by surgery,and the most common surgery was enucleation for pancreatic tumors(61.2%).Pancreatic fistula was the main complication(44.4%),while a clinically relevant complication was reported in 27 patients(23.3%).9 cases in preoperative patients were misdiagnosed,in which 8 insulinomas were misdiagnosed with epilepsy or psychosis,one SPT was misdiagnosed with pancreatic pseudocyst.Of 96 patients who were followed,one postoprative SPT relapsed and spread to the thoracic and lumbar vertebra,one postoprative SCN had new-onset diabetes mellitus,while no evidence of relapse,metastasis or death of relevant disease was found in other patients.ConclutionsPancreatic benign or low-grade malignant tumors with no characteristic clinical presentation occured more frequently in young and middle-aged females,preoperative diagnosis mainly depended on CT,surgical resection was the first choice of treatment,and enucleation was a safe and effective procedure for the treatment of benign or borderline pancreatic tumors.Immunohistochemical helped to identify SPT and PNEN.The overall prognosis of the Pancreatic benign or low-grade malignant tumors was satisfactory,while aggressive and metastatic tumors were associated with poor prognosis.