背景:据报道,超声内镜引导下细针穿刺(EUS-FNA)的病理检查可用于诊断胰腺恶性淋巴瘤(ML),但一些ML病例难以与胰腺导管腺癌(PDAC)区分。
方法:这项回顾性研究包括2006年4月至2021年10月在我们研究所进行的8例初诊时诊断为有胰头病变的ML患者和46例切除胰头PDAC的患者。在患者的临床特征和影像学检查方面比较了ML和PDAC。
结果:ML的中位肿瘤大小大于PDAC(45.8[24-64]vs.23.9[8-44]mm),但在PDAC中,尾部主胰管(MPD)的中位直径较大(2.5[1.0-3.5]vs.7.1[2.5-11.8]mm),两者都显示出这些恶性肿瘤之间的显著差异(两者,P<0.001)。在协方差分析中,MLs显示每个肿瘤大小的尾部MPD比PDAC小,具有统计学差异(P=0.042)。用sIL-2R≥658U/mL加CA19-9<37U/mL区分ML与PDAC的敏感性和特异性分别为80.0%和95.6%,分别。
结论:在某些情况下,使用细胞组织学检查通过EUS-FNA诊断胰腺ML可能是困难的。因此,如果胰腺肿瘤患者的每个肿瘤大小的MPD直径较小,则应怀疑ML。血清sIL-2R水平高,CA19-9水平正常。如果上述特征存在且仍无法确认为PDAC,应该考虑重新审查。
BACKGROUND: Pathological examination by endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) has been reported to be useful in diagnosing pancreatic malignant lymphoma (ML), but some ML cases are difficult to be differentiated from pancreatic ductal adenocarcinoma (PDAC).
METHODS: This retrospective study included 8 patients diagnosed with ML that had a pancreatic-head lesion at initial diagnosis and 46 patients with resected PDAC in the pancreatic head between April 2006 and October 2021 at our institute. ML and PDAC were compared in terms of patients\' clinical features and imaging examinations.
RESULTS: The median tumor size was larger in ML than in PDAC (45.8 [24-64] vs. 23.9 [8-44] mm), but the median diameter of the caudal main pancreatic duct (MPD) was larger in PDAC (2.5 [1.0-3.5] vs. 7.1 [2.5-11.8] mm), both showing significant differences between these malignancies (both, P < 0.001). In the analysis of covariance, MLs showed a smaller caudal MPD per tumor size than PDACs, with a statistical difference (P = 0.042). Sensitivity and specificity using sIL-2R ≥ 658 U/mL plus CA19-9 < 37 U/mL for the differentiation of ML from PDAC were 80.0% and 95.6%, respectively.
CONCLUSIONS: Diagnosing pancreatic ML using cytohistological examination through EUS-FNA can be difficult in some cases. Thus, ML should be suspected if a patient with a pancreatic tumor has a small MPD diameter per tumor size, high serum sIL-2R level, normal CA19-9 level. If the abovementioned features are present and still cannot be confirmed as PDAC, re-examination should be considered.