胰腺浆液性囊腺瘤CT表现课件.pptVIP

胰腺浆液性囊性肿瘤CT表现 2011-9 背景 胰腺浆液性囊性肿瘤（Serous cystic neoplasms,SCNs）大约占所有胰腺囊性肿瘤的20%。 镜下——囊样结构，周围包绕富含糖原的立方形细胞，细胞内含透明稀薄的浆液，同时可见血管丰富的胶原或透明样变的基质。 传统的观念认为SCN是多个微囊构成的腺瘤，影像上典型表现——蜂窝样结构，伴中心瘢痕或钙化。 背景 SCN根据肉眼所见分为5种亚型： 浆液性微囊腺瘤——传统意义上的SCN； 浆液性寡囊腺瘤 VHL相关囊性肿瘤 实性浆液性腺瘤 浆液性囊腺癌 鉴别诊断 粘液性囊腺瘤 几乎均发生于女性 约95%位于胰体尾部 典型表现——大囊（平均8-10cm）、厚壁、壁结节，少数伴钙化 如病变位于胰头、呈分叶状寡囊结构，囊壁无强化，提示SCN。 鉴别诊断 导管内乳头状粘液腺瘤 好发于老年男性，平均年龄60岁，多位于胰头 单房或多房性肿瘤，常伴分隔及壁结节；增强扫描，分隔及壁结节轻中度强化；主胰管及分支胰管不同程度扩张 常伴有胰腺的萎缩 鉴别诊断 实性假乳头状瘤 男:女 20:1 发病年龄，90%35岁，约6%50岁 通常是单发、边界清晰、囊实性病变，2.5~30cm，可发生于胰腺的任何部位，约30%伴钙化 可侵犯周围器官如胃、十二指肠、门脉、脾等，但很少侵犯胆总管 鉴别诊断 神经内分泌肿瘤 薄层CT可能有助于识别微囊结构 MR-T2序列如看到病变呈多个囊状长T2信号及内部低信号分隔有助于诊断 * Typical honeycomb pattern of serous microcystic adenoma Serous microcystic adenoma of the pancreas showing typical imaging features. Typical honeycomb pattern with peripheral oligocystic portion Atypical oligocystic pattern of serous oligocystic adenoma Serous oligocystic adenoma of the pancreas showing atypical imaging features. Atypical pleomorphic pattern of serous oligocystic adenoma Serous oligocystic adenoma of the pancreas showing atypical imaging features Atypical unilocular pattern of serous oligocystic adenoma Serous microcystic adenoma of the pancreas showing atypical imaging features of solid hypervascular pattern with oligocystic portion. Atypical solid pattern of solid serous adenoma Serous microcystic adenoma of the pancreas showing atypical imaging features. A well-demarcated hypervascular mass (arrows) with lobulated outer margin is seen in the tail of the pancreas. Note the dilatation of upstream pancreatic duct (arrowhead) and atrophy of pancreatic parenchyma. Two radiologists confused this lesion with a neuroendocrine tumor. *