目的报告小儿非功能性胰岛细胞瘤的症状、诊断及治疗。方法对3例非功能性胰岛细胞瘤患儿的资料进行回顾性分析。结果小儿非功能性胰岛细胞瘤生长缓慢，症状不典型，以腹部疼痛时轻时重、右上腹肿块为主，均手术摘除肿瘤。结论小儿非功能性胰岛细胞瘤的临床表现以腹部肿块为主，B超、CT和X线钡餐透视是主要检查手段，治疗原则是将肿瘤完整切除。
Objective To investigate differential points of clinical symptoms and pathology of solid-pseudopapillary tumor of the pancreas (SPTP) and islet cell tumor (ICT). Methods Fifteen cases of SPTP and twelve cases of ICT were studied in this retrospective research. Clinical symptom, pathologic feature and computed tomography (CT) image of patients with both tumors were analyzed, and the imaging features were compared with pathological results. Results The mean age of SPTP patients was 22.4 year-old. Twelve patients with SPTP presented a palpable abdominal mass as the initial symptom. It was observed that the tumor cells were located in a pseudopapillary pattern with a fibro-vascular core histologically. On the CT images, a mixture of solid and cystic structures could be seen in all the tumors. After taking enhanced CT scan, the solid portion was slightly enhanced in the arterial phase and the contrast intensity increased in the portal venous phase. On the other hand, the mean age of ICT patients was 39.3 year-old. The major symptom was due to the function of islet cell tumor, which was typical in 8 patients, presenting as Whipple triad. Histologically, cells demonstrated in trabecular, massive, acinar or solid patterns, and the blood supply of the tumor was abundant. On the CT images, most small tumors were difficulty to be detected. ICT could be markedly enhanced in the arterial phase and slightly enhanced in the portal venous phase on post-contrast CT scan. Conclusion Clinical symptom, pathologic feature and CT scanning are helpful to differentiate SPTP from ICT.
【Abstract】ObjectiveTo investigate the value of volumetric interpolated breathhold examination (3DVIBE) MRI sequence in the diagnosis of functional islet cell tumors of the pancreas. MethodsDedicated MRI scan was performed for 3 patients suspected to have functional islet cell tumors of the pancreas on clinical and laboratory basis. The MRI scan protocol included routine axial T1W and T2W, coronal true fast imaging with steady state procession (TrueFISP) and MRCP, gadoliniumenhanced 3DVIBE dynamic triphasic acquisitions and enhanced 2D GRE T1W scan. The three phases images of 3DVIBE sequence were acquired at 15 s, 40 s and 65 s after injection of contrast agent, corresponding to the early arterial, late arterial and portal venous phase respectively. The imaging features were compared with surgical and pathological findings. ResultsThe triphasic images of 3DVIBE sequence depicted clearly the morphology of small functional islet cell tumors of the pancreas and reflected accurately the characteristics of tumor blood supply, while other MRI sequences might miss these small lesions. ConclusionThinslice and fast dynamic MRI sequence, as exemplified by 3DVIBE sequence, is very useful in the detection and characterization of pancreatic functional islet cell tumors.
目的总结胰腺血管活性肠肽瘤（VIPoma）的临床特点并探讨其诊治方法。 方法回顾性分析1991年11月至2010年2月期间我院收治的3例VIPoma患者的临床资料。 结果3例均有周期性发作水样泻、低钾血症和低或无胃酸。有2例血浆血管活性肠肽值显著升高。B超及CT发现3例肿瘤均位于胰腺内，其中1例肝转移，1例怀疑肝转移。3例均行手术治疗。1例肿瘤位于胰头部行胰十二指肠切除术，随访3年无肿瘤复发；1例肿瘤位于胰头颈部及肝脏多发转移灶，行胰腺头颈部切除及肝脏转移结节摘除术，术后4个月腹泻症状复发，证实肝脏多发转移灶，又先后3次手术，于第1次手术后3.5年死于电解质紊乱；另1例术中发现肿瘤位于胰头部无法切除，肝脏多发转移灶，摘除1枚肝脏结节病理确认为转移癌，术后间断应用奥曲肽，术后2.5年仍在随访中。 结论VIPoma首选的治疗方法是手术切除肿瘤。恶性肿瘤即使无法根治手术，也应该姑息性切除和间断应用奥曲肽，以改善患者生活质量。