| Part1 Solid pseudopapillary neoplasm of the pancreas: Clinical and pathological features in 227 cases.AIM: To investigate the clinical and pathological features of solid pseudopapillary neoplasm of pancreas(SPN)in our hospital.METHODS: A retrospective analysis of 227 patients diagnosed and treated for SPN in our hospital over 15 years(2000-2015)was carried out.Immunohistochemical staining of CAM5.2,Vimentin,NSE,Cg A,Syn,?-catenin and Ki-67 were performed in most of the patients.The clinico-pathological and immunohistochemical data were obtained and analysed.RESULT: 81.9% of patients with SPN were female(186/227).Mean age at diagnosis=33.6 years(9-82).53.7% patients were found by taking a physical examination.32.6% patients had abdominal pain as the first symptom.Mean tumor size=5.38cm(0.5-20cm).48.5% tumors localized to the pancreatic tail,and 33% localized to the head.46.3% tumors were cystic and solid,42.3% were solid,and 11.4% were cystic.There were 2 cases of lymph node metastasis(0.9%),15 cases of vascular tumor thrombus(6.6%),14 cases of nerve invasion(6.2%),and 13 cases of invasion of adjacent organs(5.7%).All the 227 patients were taken up for surgery.There are 165 cases have complete follow-up data.Patients were free of disease in a median follow-up period of 51.1 months(range 9.9-167.1 months).162 patients were(162/165)survived.5 had liver metastasis.Recurrence was seen in only one case.The immunohistochemical results were that 40.6% CAM5.2(88/217),98.5%Vimentin(207/216),96%NSE,22.4%Syn(24/107),10.2%Cg A(13/127),the proliferation index of Ki-67 was low,and most cases were less than 2%.?-catenin expressed in nucleus and cytoplasm in SPN,and even part of the membrane is positive,but only to the nuclear positive is positive.Due to the existence of the cytoplasm and membrane coloring,brings some interference to determine the nuclear positive.Its positive rate was 96.6%(144/149),and it is also expressed in normal pancreatic tissues in cytoplasm and membrane and showed nucleus and cytoplasmic staining in 1 case of acinic cell carcinoma.CONCLUSIONS: SPN is a rare pancreatic tumor and predominantly encountered in young female patients.Its clinical manifestations are not specific and a small number has aggressive manifestation.Patients with SPN have an excellent prognosis after surgical excision.The expression of ?-catenin in SPN was sometimes specific,but the co-existence of the cytoplasm and membrane coloring made it difficult to determine the nuclear positive.Part2 The value of LEF-1 and P504 S in the diagnosis of solid pseudopapillary neoplasm of pancreasAIM: To investigate the application value of LEF-1 and P504 S in the diagnosis of SPN.METHODS: 167 cases of SPN,20 cases of pancreatic ductal adenocarcinoma,25 cases of pancreatic neuroendocrine tumors(including G1,G2,G3),22 cases of intraductal papillary mucinous neoplasms,11 cases of acinic cell carcinoma and 1 cases of pancreatoblastoma were included.LEF1 and P504 S immunohistochemical staining were performed and results were analysed.RESULLT: There are 164 cases(164/167,98.2%)with SPN expressed LEF-1 with strong nuclear positive.But no clear expression of LEF-1 can be seen in normal pancreatic tissusss,negative cases in which there were 1 cases of hemorrhagic necrosis.20 cases of pancreatic ductal adenocarcinoma,25 cases of pancreatic neuroendocrine tumors,22 cases intraductal papillary mucinous neoplasms,11 cases of acinic cell carcinoma and 1 case of pancreatoblastoma were negative.There were 160 cases(160/167,95.8%)of SPN express P504 S in the tumor tissues with strong cytoplasm positive,the normal pancreatic tissue was negative.Negative expression of P504 S in 20 cases of pancreatic ductal adenocarcinoma,22 cases of intraductal papillary mucinous neoplasms and 1 cases of pancreatoblastoma,2 cases of positive expression in 25 cases of pancreatic neuroendocrine tumors(2/23),1 case positive in 11 of acinic cell carcinoma(1/11).CONCLUSION: The positive expression of LEF-1 and P504 S in SPN in the rate reached above 95%,and its expression compared to other pancreatic tumors with remarkable specificity.It can be used as one of the specific markers of SPN diagnosis and differential diagnosis,its specificity is higher than that of ?-catenin.Part3 Clinical and pathological features of solid pseudopapillary neoplasm of the pancreas in different gender and prognosisAIM: To analyze the clinical and pathological features of solid pseudopapillary neoplasmof the pancreas and its significance in different gender and prognosis.METHODS: SPSS 19 statistical software was used to analyze the clinical pathological data and immunohistochemical results of the first two parts of SPN.RESULT: In sex,the accuracy of clinical diagnosis,vascular invasion,perineural invasion in male and female are significantly different between the two groups(P < 0.05),but no difference between the 8 parameters including prognosis,chief complaint,surgical approach,the surrounding normal tissue boundaries,lymph node metastasis,invasion of surrounding organs,the real situation of the transverse capsule and the tumor site(P > 0.05).Immunohistochemical results showed that only CAM5.2 had significant differences between the sexes.When the prognosis was divided into survival group and no adverse prognosis group(including recurrence,metastasis and death),those 10 indicators including the correct rate of clinical diagnosis,gender,surgical method,tumor and surrounding normal tissue boundaries,lymph node metastasis,vascular invasion,perineural invasion and adjacent organ invasion,the real situation of the transverse capsule and tumor location had no effect on the prognosis.The expression of the 7 indicators of immunohistochemistry of CAM5.2,Vim,NSE,Syn,Cg A,?-catenin,LEF-1,P504 S between the two groups have no difference in prognosis.Through the analysis of the individual age and tumor size,age also had no effect on the prognosis,but when the tumor diameter greater than 9.75 cm,there are significant differences between the two groups of patients(P < 0.05),and indicates poor prognosis.In addition,we found a significant difference in the prognosis between the groups when Ki-67=4%(P=0.000),indicating that when the Ki-67 index is greater than 4% of patients with poor prognosis.COUCLUSION: SPN is more likely to occur in women with vascular invasion and perineurial invasion,and is more likely to be diagnosed than in men.SPN patients with tumor diameter greater than 9.75 cm and Ki-67 index greater than 4% may indicate poor prognosis. |
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