Læknablaðið - 15.06.1995, Blaðsíða 23

LÆKNABLAÐIÐ 1995; 81
469
Belgæxli í brisi
Þrjú sjúkratilfelli og yfirlit
Steinar Guðmundsson1’, Bjarni A. Agnarsson21, Gunnar Gunnlaugsson3’, Jónas Magnússon1*
Guðmundsson S, Agnarsson BA, Gunnlaugsson G,
Magnússon J
Cystadenoma of the pancreas. Three case reports
and a review
Læknablaðið 1995; 81: 469-76
Cystic neoplasms of the pancreas are pathologically
divided into macrocystic and microcystic adenomas.
Macrocystic adenomas are multilocular, composed
of large cysts (>2 cm), with or without septa, lined
with columnar mucin-producing epithelium. This
type has malignant potential. The microcystic ade-
nomas are composed of many tiny cysts (<2 cm)
lined by small cuboidal cells containing glycogen but
little or no mucin. This adenoma is completely be-
nign and is therefore important to differentiate from
the former. Cystadenomas represent 10-15% of cys-
tic lesions of the pancreas. Roughly one-half of the
cystadenomas of the pancreas are found to be micro-
cystic. The-remainder is accounted for by the muci-
nous cystic neoplasms, either macrocystic adenomas
or cystadenocarcinomas. These adenomas occur
most frequently in middle aged women. Upper ab-
dominal pain and weight loss are often the present-
ing symptoms. An abdominal mass can often be
palpated during physical examination of these pa-
tients. Ultrasound and CT of the abdomen are the
most useful diagnostic tools in the evaluation of
cystic lesions of the pancreas. CT can also be helpful
in differentiating microcystic from macrocystic ade-
Frá "handlækningadeild Landspítalans, 2)Rannsóknastofu
Háskólans í meinafræði, 3lhandlækningadeild Borgarspítal-
ans. Fyrirspurnir, bréfaskipti: Steinar Guðmundsson, hand-
lækningadeild Landspítalans, 101 Reykjavík.
nomas. It is possible to do a CT or ultrasound guided
percutaneous aspiration for diagnosis of the lesions.
This technique permits preoperative cytologic and
biochemical analysis of the cyst content. Surgery
however is often necessary for accurate diagnosis
where the tumor is biopsied for histology. The pri-
mary pancreatic lesions to be considered in the dif-
ferential diagnosis include pseudocyst, whether of
inflammatory or traumatic origin, congenital cysts,
ductal adenocarcinoma or islet cell tumors. Some
agree that surgical resection may not be mandatory
if an accurate diagnosis of microcystic adenoma can
be made. Others emphasize that all pancreatic cys-
tadenomas can have malignant potential and that
total excision should be the treatment of choice.
Both macrocystic adenomas and cystadenocarcino-
mas have a slow and indolent course and tend to be
well resectable in spite of late diagnosis.
Three cases of pancreatic cystadenomas have been
diagnosed in Iceland since 1972. These cases are
presented here with a review of the literature.
Ágrip
Góðkynja belgkirtilæxlum eða belgæxlum í
brisi (cystadenoma pancreatis) hefur verið
skipt meinafræðilega í tvo flokka: Stórbelgja-
æxli (macrocystic adenoma) og smábelgjaæxli
(microcystic adenoma). Stórbelgjaæxlin eru
mynduð af stórum belgjum (>2 cm), með eða
án milliveggja, þöktum að innan stórum slím-
myndandi frumum. Þau verða iðulega illkynja.
Smábelgjaæxlið inniheldur litla belgi (<2 cm),
klædda flatri eða teningslaga þekju sem hefur
að geyma fjölsykrunga (glycogen) og lítið eða
ekkert slím. Mikilvægt er að greina þetta æxli
vegna þess að það er fullkomlega góðkynja.
Belgæxli eru um 10-15% belgmeina (cystic les-
ions) í brisi. Rúmlega helmingur belgæxla í
brisi reynist vera smábelgjaæxli. Hinn helm-