Cyst fluid cytologic analysis in the differential diagnosis of pancreatic cystic lesions.
Cyst fluid cytologic analysis in the differential diagnosis of pancreatic cystic lesions.
复制标题
囊液细胞学分析在胰腺囊性病变鉴别诊断中的应用。
DOI：
10.1093/ajcp/101.4.483
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发表时间：
1994
影响因子：
3.5
通讯作者：
Southern,JF
中科院分区：
文献类型：
--
作者：
Centeno,BA;Lewandrowski,KB;Warshaw,AL;Compton,CC;Southern,JF
胰腺囊性病变包括炎性假性囊肿、良性浆液性囊腺瘤和黏液性肿瘤，其中一些是恶性的。囊肿液的细胞学分析已被建议在确定治疗前诊断胰腺囊肿。作者报告31例胰腺囊肿的分析：9例假性囊肿，5例浆液性囊腺瘤，8例粘液囊性肿瘤，4例粘液囊腺癌，2例乳头状囊腺癌，1例粘液导管腺癌伴囊性变性，2例囊性胰岛细胞瘤。所有假性囊肿都被正确归类为可能的炎性病变，因为存在大量的急性炎症和组织细胞，而没有腺上皮。5例浆液性囊腺瘤中有3例是正确分类的，基于小立方体细胞簇和含有糖原的微泡细胞质的存在。12个黏液性肿瘤中有11个为圆形细胞，含有大的细胞质黏液液泡或柱状细胞，含有细胞质黏液。7例癌中5例诊断为恶性，1例为可疑恶性，1例因缺乏细胞成分而无法诊断。作者认为，胰腺囊肿液细胞学分析有助于区分粘液性和非粘液性胰腺囊肿，并可能提供明确的恶性证据。在某些情况下，浆液性囊腺瘤可根据细胞学分析诊断。没有上皮细胞的炎性涂片提示假性囊肿，但这些结果是非特异性的，因为当囊性肿瘤经历退行性改变时也可能出现类似的模式。因此，假性囊肿仍然是一种排除性诊断。
Pancreatic cystic lesions include inflammatory pseudocysts, benign serous cystadenomas, and mucinous neoplasms, some of which are malignant. Cytologic analysis of cyst fluid has been proposed to diagnose pancreatic cysts before definitive therapy. The authors report an analysis of 31 pancreatic cyst aspirates: 9 pseudocysts, 5 serous cystadenomas, 8 mucinous cystic neoplasms, 4 mucinous cystadenocarcinomas, 2 papillary cystadenocarcinomas, 1 mucinous ductal adenocarcinoma with cystic degeneration, and 2 cystic islet cell tumors. All pseudocysts were correctly classified as probable inflammatory lesions, because of the presence of abundant acute inflammation and histiocytes and the absence of glandular epithelium. Three of five serous cystadenomas were correctly classified, based on the presence of small cuboidal cells in clusters with microvesicular cytoplasm containing glycogen. Eleven of 12 mucinous tumors contained round cells with large cytoplasmic mucin vacuoles or columnar cells containing cytoplasmic mucin. Malignancy was diagnosed in 5 of 7 carcinomas, 1 case was classified as suspicious for malignancy, and 1 case was nondiagnostic because of the absence of a cellular component. The authors concluded that pancreatic cyst fluid cytologic analysis is useful in differentiating mucinous from nonmucinous pancreatic cysts and may provide definitive evidence of malignancy. In some cases, serous cystadenoma can be diagnosed based on cytologic analysis. An inflammatory smear without epithelial cells suggests a pseudocyst, but these findings are nonspecific, as a similar pattern may occur when a cystic neoplasm undergoes degenerative changes. Therefore, pseudocyst remains a diagnosis of exclusion.