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Al Shamousi K, Al-Busafi SA, Kashoob M, Al Zadjali A, Al Kaabi H. Mucinous Cystic Neoplasm of the Pancreas in Pregnancy: A Case Report. Cureus 2023; 15:e50446. [PMID: 38222172 PMCID: PMC10785736 DOI: 10.7759/cureus.50446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/16/2024] Open
Abstract
Mucinous cystic neoplasms (MCNs) of the pancreas are rare epithelial neoplasms, characterized by an inner epithelial layer and an ovarian-type sub-epithelial stroma. These lesions are typically benign but can pose challenges during pregnancy due to their rapid growth potential, associated risk of malignant transformation, and complications such as pancreatitis. We present a case of a 39-year-old pregnant female with a history of recurrent acute pancreatitis, diagnosed with an MCN during pregnancy. Diagnostic procedures were deferred until after delivery, followed by successful distal pancreatectomy. This case underscores the importance of individualized management strategies in pregnant patients with pancreatic MCNs, balancing the need for timely intervention with maternal and fetal safety. Long-term follow-up is generally unnecessary for MCNs without associated invasive carcinoma, emphasizing the favorable prognosis of these lesions following complete surgical resection.
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Affiliation(s)
| | - Said A Al-Busafi
- Gastroenterology, Sultan Qaboos University Hospital, Muscat, OMN
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2
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Musleh A, Abbadi K, Asbah M, Nofal M, Hilal MA, Khader A. Rare clinical entity of diffuse mucinous cystic neoplasm of the pancreas: A case report and review of the literature. Int J Surg Case Rep 2023; 111:108859. [PMID: 37742357 PMCID: PMC10520792 DOI: 10.1016/j.ijscr.2023.108859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/19/2023] [Accepted: 09/19/2023] [Indexed: 09/26/2023] Open
Abstract
INTRODUCTION Mucinous cystic neoplasm is a rare premalignant tumor of the pancreas typically affects middle aged women. Mostly it affects the body and the tail of the pancreas and in very rare cases it may affect the head. CASE PRESENTATION A 56-year-old female patient, previously diagnosed with type 2 diabetes mellitus, and with an unremarkable medical and surgical history except for a laparoscopic cholecystectomy and multiple admissions due to colonic diverticular disease, which ultimately required a left hemicolectomy. Recently, the patient has been experiencing a gradual onset of symptoms, including persistent right upper quadrant and epigastric pain. This pain has been progressively worsening, characterized by a constricting sensation, radiating to the back. Additionally, the patient has reported a feverish sensation, yellowish discoloration of the skin over the past two months, itching, nausea, and a notable loss of appetite. Within the last two months, there has also been a significant weight loss of 10 kg. A thorough evaluation led to a diagnosis of diffuse mucinous cystic neoplasm, which involves the entire pancreas. DISCUSSION Due to its categorization as a premalignant abnormality, swift surgical action is imperative following diagnosis to minimize the possibility of evolving into a malignant state. This strategy is vital to secure the best possible results for the patient and to lower the likelihood of progression to more advanced malignant stages. CONCLUSION To our knowledge, this is one of the few reported cases of diffuse histology-proven MCN of the pancreas.
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Affiliation(s)
- Asil Musleh
- Department of General Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine
| | - Khaled Abbadi
- Department of General Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine.
| | - Malvina Asbah
- Department of General Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine
| | - Mohammed Nofal
- Department of Radiology, Palestinian Medical Complex (PMC), Ramallah, Palestine
| | - Mayar Abu Hilal
- Department of General Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine
| | - Abdellatif Khader
- Department of General Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine; Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
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Xia Q, Li F, Min R, Sun S, Han YX, Feng ZZ, Li N. Malignancy risk factors and prognostic variables of pancreatic mucinous cystic neoplasms in Chinese patients. World J Gastroenterol 2023; 29:3119-3132. [PMID: 37346158 PMCID: PMC10280801 DOI: 10.3748/wjg.v29.i20.3119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/21/2023] [Accepted: 05/04/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Pancreatic mucinous cystic neoplasms (MCNs) represent one of the precursor lesions of pancreatic ductal adenocarcinoma, and their detection has been facilitated by advances in preoperative imaging. Due primarily to the rarity of MCNs, however, there is limited knowledge regarding the prognostic variables and high-risk factors for malignant transformation. A more comprehensive and nuanced approach is necessary to fill this gap and provide a basis for improved treatment decisions and patient outcomes.
AIM To investigate the high-risk factors associated with malignant MCNs and to explore the prognostic factors of MCN with associated invasive carcinoma (MCN-AIC).
METHODS All cases of resected MCNs from a single high-volume institution between January 2012 and January 2022 were retrospectively reviewed. Only cases with ovarian-type stroma verified by progesterone receptor staining were included. Preoperative features, histological findings and postoperative course were documented. Multivariate logistic regression was employed to investigate variables related to malignancy. Survival analysis was performed using the Kaplan-Meier curve, and the prognostic factors were assessed to evaluate the postoperative course of patients with MCN-AIC.
RESULTS Among the 48 patients, 36 had benign MCNs, and 12 had malignant MCNs (1 high-grade atypical hyperplasia and 11 MCN-AIC). Age, tumour size, presence of solid components or mural nodules and pancreatic duct dilatation were identified as independent risk factors associated with malignancy. The follow-up period ranged from 12 mo to 120 mo, with a median overall survival of 58.2 mo. Only three patients with MCN-AIC died, and the 5-year survival rate was 70.1%. All 11 cases of MCN-AIC were stage I, and extracapsular invasion was identified as a prognostic factor for poorer outcomes.
CONCLUSION The risk factors independently associated with malignant transformation of MCNs included age, tumour size, presence of solid components or mural nodules, and pancreatic duct dilatation. Our study also revealed that encapsulated invasion was a favourable prognostic factor in MCN-AIC patients.
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MESH Headings
- Humans
- Carcinoma, Pancreatic Ductal/epidemiology
- Carcinoma, Pancreatic Ductal/pathology
- Carcinoma, Pancreatic Ductal/surgery
- East Asian People
- Neoplasms, Cystic, Mucinous, and Serous/epidemiology
- Neoplasms, Cystic, Mucinous, and Serous/pathology
- Neoplasms, Cystic, Mucinous, and Serous/surgery
- Pancreatic Neoplasms/epidemiology
- Pancreatic Neoplasms/pathology
- Pancreatic Neoplasms/surgery
- Prognosis
- Receptors, Progesterone
- Retrospective Studies
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Affiliation(s)
- Qing Xia
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Bengbu Medical College, Bengbu 233004, Anhui Province, China
| | - Fan Li
- Department of Pathology, Bengbu Medical College, Bengbu 233030, Anhui Province, China
| | - Rui Min
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Bengbu Medical College, Bengbu 233004, Anhui Province, China
| | - Shuai Sun
- Department of Pathology, Bengbu Medical College, Bengbu 233030, Anhui Province, China
| | - Yue-Xin Han
- School of Clinical Medicine, Bengbu Medical College, Bengbu 233030, Anhui Province, China
| | - Zhen-Zhong Feng
- Department of Pathology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
| | - Nan Li
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Bengbu Medical College, Bengbu 233004, Anhui Province, China
- Department of Pathology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
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Dhamor D, Irrinki S, Naik A, Kurdia KC, Rastogi P, Gupta P, Kapoor VK. Pregnancy-associated mucinous cystic neoplasms of the pancreas - A systematic review. Am J Surg 2023; 225:630-638. [PMID: 36424200 DOI: 10.1016/j.amjsurg.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 11/02/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Mucinous cystic neoplasms (MCN) are mucin-producing epithelial cell tumors of pancreas. They consist of an ovarian-type stroma expressing estrogen and progesterone receptors. Pregnancy-associated MCNs are presumed to be larger in size and more aggressive without any concrete evidence. OBJECTIVE and Data Sources: Systematic review of published literature using PubMed and Google Scholar databases. Original articles including case reports and series published between 1970&2021 were included wherein MCN was diagnosed during pregnancy/within one-year post-partum. Thirty-three publications having 36 cases, adding one of our own patient were analyzed in this review. RESULT Median age at presentation was 32 years. Only three (9%) patients were asymptomatic. Mean size of MCN was 135 mm. Ten patients (27%) reported an increase in size during pregnancy. Most tumors involved body and tail of pancreas (60%). Distal pancreatectomy with splenectomy was the most common resection performed (57%). No foetal mortality was reported to date. CONCLUSION Pregnancy may cause a rapid increase in size of MCN. Decision-making is more complex and needs a fine balance between optimal oncological and obstetric outcomes.
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Affiliation(s)
- Devesh Dhamor
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Santhosh Irrinki
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anil Naik
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kailash Chand Kurdia
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Pulkit Rastogi
- Department of Haematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vinay K Kapoor
- Department of Hepato-pancreato-biliary (HPB) Surgery, Mahatma Gandhi Medical College and Hospital (MGMCH), Jaipur, India
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Chen W, Ahmed N, Krishna SG. Pancreatic Cystic Lesions: A Focused Review on Cyst Clinicopathological Features and Advanced Diagnostics. Diagnostics (Basel) 2022; 13:diagnostics13010065. [PMID: 36611356 PMCID: PMC9818257 DOI: 10.3390/diagnostics13010065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/13/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022] Open
Abstract
Macroscopic, endomicroscopic, and histologic findings and correlation are an integral part of the diagnostic evaluation of pancreatic cystic lesions (PCLs), as complementing morphologic features seen by different specialties are combined to contribute to a final diagnosis. However, malignancy risk stratification of PCLs with worrisome features can still be challenging even after endoscopic ultrasound guided-fine needle aspiration (EUS-FNA) with cytological evaluation. This review aims to summarize cyst clinicopathological features from the pathologists' perspective, coupled with knowledge from advanced diagnostics-confocal laser endomicroscopy and cyst fluid molecular analysis, to demonstrate the state-of-art risk stratification of PCLs. This review includes illustrative photos of surgical specimens, endomicroscopic and histologic images, and a summary of cyst fluid molecular markers.
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Affiliation(s)
- Wei Chen
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- Correspondence:
| | - Nehaal Ahmed
- School of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Somashekar G. Krishna
- Division of Gastroenterology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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Pancreatic Incidentaloma. J Clin Med 2022; 11:jcm11164648. [PMID: 36012893 PMCID: PMC9409921 DOI: 10.3390/jcm11164648] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022] Open
Abstract
Pancreatic incidentalomas (PIs) represent a clinical entity increasingly recognized due to advances in and easier access to imaging techniques. By definition, PIs should be detected during abdominal imaging performed for indications other than a pancreatic disease. They range from small cysts to invasive cancer. The incidental diagnosis of pancreatic cancer can contribute to early diagnosis and treatment. On the other hand, inadequate management of PIs may result in overtreatment and unneeded morbidity. Therefore, there is a strong need to evaluate the nature and clinical features of individual PIs. In this review, we summarize the major characteristics related to PIs and present suggestions for their management.
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7
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Hu F, Hu Y, Wang D, Ma X, Yue Y, Tang W, Liu W, Wu P, Peng W, Tong T. Cystic Neoplasms of the Pancreas: Differential Diagnosis and Radiology Correlation. Front Oncol 2022; 12:860740. [PMID: 35299739 PMCID: PMC8921498 DOI: 10.3389/fonc.2022.860740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 02/04/2022] [Indexed: 12/18/2022] Open
Abstract
Although the probability of pancreatic cystic neoplasms (PCNs) being detected is raising year by year, their differential diagnosis and individualized treatment are still a challenge in clinical work. PCNs are tumors containing cystic components with different biological behaviors, and their clinical manifestations, epidemiology, imaging features, and malignant risks are different. Some are benign [e.g., serous cystic neoplasms (SCNs)], with a barely possible that turning into malignant, while others display a low or higher malignant risk [e.g., solid pseudopapillary neoplasms (SPNs), intraductal papillary mucinous neoplasms (IPMNs), and mucinous cystic neoplasms (MCNs)]. PCN management should concentrate on preventing the progression of malignant tumors while preventing complications caused by unnecessary surgical intervention. Clinically, various advanced imaging equipment are usually combined to obtain a more reliable preoperative diagnosis. The challenge for clinicians and radiologists is how to accurately diagnose PCNs before surgery so that corresponding surgical methods and follow-up strategies can be developed or not, as appropriate. The objective of this review is to sum up the clinical features, imaging findings and management of the most common PCNs according to the classic literature and latest guidelines.
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Affiliation(s)
- Feixiang Hu
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yue Hu
- Hefei Cancer Hospital, Chinese Academy of Sciences (CAS), Hefei, China
| | - Dan Wang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, China
| | - Xiaowen Ma
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yali Yue
- Children's Hospital, Fudan University, Shanghai, China
| | - Wei Tang
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wei Liu
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Puye Wu
- General Electric (GE) Healthcare, Shanghai, China
| | - Weijun Peng
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Tong Tong
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Yoon SJ, Kim H, Lee O, Jung JH, Lim CS, Shin YC, Kwon W, Jang JY, Shin SH, Heo JS, Han IW. Development and external validation of a nomogram with inflammatory markers for predicting invasiveness of intraductal papillary mucinous neoplasm of pancreas. Medicine (Baltimore) 2022; 101:e29036. [PMID: 35356913 PMCID: PMC10684245 DOI: 10.1097/md.0000000000029036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 02/19/2022] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Recent studies have reported that inflammatory markers, such as neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and advanced lung cancer inflammation index, are associated with invasiveness of intraductal papillary mucinous neoplasm (IPMN). This study aimed to develop and validate a new nomogram that includes inflammatory markers for predicting the invasiveness of IPMN.The data of 365 patients who underwent surgical resection for IPMN at 4 centers between 1995 and 2016 were retrospectively reviewed to develop a new nomogram. For external validation, a separate patient cohort was used. The predictive ability of the nomogram was evaluated using the area under the receiver operating characteristic curve.The new nomogram was developed using the following variables which were identified as risk factors for invasive IPMN: body mass index, preoperative serum bilirubin level, carbohydrate antigen 19-9, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, advanced lung cancer inflammation index, main duct type, presence of solid portion, and tumor size. After external validation, the area under the curve value was 0.649 (95% CI: 0.578-0.720, P < .001).To the best of our knowledge, this study is the first to predict and externally validate the invasiveness in IPMN using inflammatory markers. Further research is necessary to improve predictability of the model for selecting patients for surgical resection.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - In Woong Han
- Correspondence: In Woong Han, Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School ofMedicine, 81, Irwon-ro, Gangnam-gu, Seoul 06351, South Korea (e-mail: ).
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9
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Lee YJ, Kim SW, Kim Y. Ovarian mass combined with pancreatic neoplasm in pregnancy: A rare case report and literature review. J Obstet Gynaecol Res 2021; 48:244-250. [PMID: 34729873 DOI: 10.1111/jog.15085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 09/22/2021] [Accepted: 10/17/2021] [Indexed: 01/18/2023]
Abstract
A 35-year-old woman presented with abdominal discomfort at 26 weeks gestation. The magnetic resonance imaging demonstrated a huge unilocular cystic mass with mural nodules originated from body and tail of pancreas. There was also a cystic mass in the left ovary with suppressed intensity on fat saturated image. One week later, she complained of worsening left lower abdominal pain and dyspnea as a new symptom. Hence, distal pancreatectomy with splenectomy and left ovarian cystectomy were performed. The huge cystic mass of pancreas was compressing the diaphragm, and left tubo-ovarian torsion was observed. This is the second case wherein an MCN of the pancreas with mature cystic teratoma of the ovary caused different symptoms. The management of MCNs in pregnant women should consider multiple aspects such as the malignancy potential of imaging findings, severity of symptoms, and fetal well-being.
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Affiliation(s)
- Young Joo Lee
- Department of Obstetrics and Gynecology, Kyung Hee Medical Center, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - So-Woon Kim
- Department of Pathology, Kyung Hee Medical Center, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Youngsun Kim
- Department of Obstetrics and Gynecology, Kyung Hee Medical Center, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
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Liang H, Xie W, Lin X, Wang T, Xie J, Wang C, Xiao S, Guo Y. Pathologic T1 and T2 encapsulated invasive carcinomas arising from mucinous cystic neoplasms of the pancreas have favorable prognosis and might be treated conservatively. J Pathol Clin Res 2021; 7:507-516. [PMID: 34062050 PMCID: PMC8363923 DOI: 10.1002/cjp2.225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/22/2021] [Accepted: 04/22/2021] [Indexed: 12/28/2022]
Abstract
Carcinoma arising from a mucinous cystic neoplasm (MCN) of the pancreas is termed MCN with associated invasive carcinoma (MCN-AIC) in the fifth WHO classification of digestive tumors (2019). The prognosis of this malignancy varies depending on the relationship of the invasive carcinoma to the cyst capsule, but limited data are available. This study identified 165 surgically resected MCNs including 15 MCN-AICs from a single center between 2008 and 2018 and analyzed their clinicopathologic features. The results confirmed that non-invasive MCNs were completely cured by surgery. All MCN-AICs showing an encapsulated invasion pattern (defined as invasive carcinoma limited to the ovarian-type stroma, cystic septa, and capsule) had an excellent prognosis with a 5-year survival rate of 100%, even when the size of the invasive component was up to stage T2. By contrast, MCN-AICs with extracapsular involvement had unfavorable clinical outcomes. Our study demonstrates that the pattern of invasion of MCN-AIC can predict patient prognosis. Pathologic stage T1 and T2 encapsulated MCN-AICs may be completely cured with surgical resection alone or when combined with postoperative chemotherapy.
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MESH Headings
- Adult
- Female
- Humans
- Male
- Middle Aged
- Neoplasm Grading
- Neoplasm Invasiveness/diagnostic imaging
- Neoplasm Invasiveness/pathology
- Neoplasms, Cystic, Mucinous, and Serous/diagnosis
- Neoplasms, Cystic, Mucinous, and Serous/diagnostic imaging
- Neoplasms, Cystic, Mucinous, and Serous/pathology
- Neoplasms, Cystic, Mucinous, and Serous/surgery
- Pancreas/diagnostic imaging
- Pancreas/pathology
- Pancreas/surgery
- Pancreatectomy
- Prognosis
- Survival Rate
- Tomography, X-Ray Computed
- Treatment Outcome
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Affiliation(s)
- Huaiyu Liang
- Department of PathologyRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiPR China
| | - Wen Xie
- Department of PathologyRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiPR China
- Department of PathologyZhong'nan Hospital of Wuhan UniversityWuhanPR China
| | - Xiaozhu Lin
- Department of PathologyRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiPR China
- Department of RadiologyRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiPR China
| | - Ting Wang
- Department of PathologyRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiPR China
| | - Jing Xie
- Department of PathologyRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiPR China
| | - Chaofu Wang
- Department of PathologyRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiPR China
| | - Shu‐Yuan Xiao
- Department of PathologyZhong'nan Hospital of Wuhan UniversityWuhanPR China
- Department of PathologyUniversity of Chicago MedicineChicagoILUSA
| | - Yan Guo
- Department of PathologyRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiPR China
- Histo Pathology Diagnostic CenterShanghaiPR China
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Lim HJ, Kang HS, Lee JE, Min JH, Shin KS, You SK, Kim KH. Sarcomatoid carcinoma of the pancreas — multimodality imaging findings with serial imaging follow-up: A case report and review of literature. World J Clin Cases 2021; 9:3102-3113. [PMID: 33969097 PMCID: PMC8080743 DOI: 10.12998/wjcc.v9.i13.3102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/28/2021] [Accepted: 03/04/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sarcomatoid carcinoma of the pancreas is extremely rare and has an extremely poor prognosis. Although a few cases of sarcomatoid carcinoma of pancreas have been reported, most are focused on a histopathological review. To the best of our knowledge, there are no reports documenting multimodality imaging characteristics and chronological changes with emphasis on radiologic features.
CASE SUMMARY A 64-year-old woman was admitted to Chungnam National University Hospital with acute appendicitis. Contrast-enhanced computed tomography of the abdomen revealed a 2.6 cm × 2.8 cm multilobular cystic mass in the pancreatic tail. The pancreatic lesion showed suspected mural nodules and thin septa. Hence, mucinous cystic neoplasm of pancreas was considered. After 7 mo, the patient was readmitted for repeated epigastric abdominal pain and nausea. Follow-up contrast-enhanced computed tomography of the abdomen and magnetic resonance imaging revealed a marked enlargement (5.4 cm × 4 cm), with a predominant internal solid component. The mass showed low signal intensity on a T1-weighted image and heterogeneously intermediate high signal intensity on a T2-weighted image. It showed diffusion restriction and peripheral rim enhancement on an arterial phase image, and progressive enhancement on portal venous and delayed phase images. Distal pancreatectomy was performed. Based on the morphology and immunohistochemical staining of the specimen, pancreatic sarcomatoid carcinoma was diagnosed.
CONCLUSION We present the computed tomography, magnetic resonance imaging, and positron emission tomography computed tomography findings, pathologic features, and chronological changes for preoperative diagnosis.
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Affiliation(s)
- Hyun Jae Lim
- Department of Radiology, Chungnam National University Hospital, Daejeon 35015, South Korea
| | - Hye Seon Kang
- Department of Radiology, Chungnam National University Hospital, Daejeon 35015, South Korea
| | - Jeong Eun Lee
- Department of Radiology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon 35015, South Korea
| | - Ji Hye Min
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
| | - Kyung Sook Shin
- Department of Radiology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon 35015, South Korea
| | - Sun Kyoung You
- Department of Radiology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon 35015, South Korea
| | - Kyung-Hee Kim
- Department of Pathology, Cancer Research Institute, College of Medicine, Chungnam National University, Daejeon 35015, South Korea
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12
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Farahmandi S, Elessawy M, Bauerschlag DO, Pecks U, Abdullazade S, Beckmann JH, Heilmann T, Rumpf AL, Maass N, Jansen P, Winkler V. Mucinous Cystic Neoplasm of Pancreas in a Pregnant Woman Presenting with Severe Anemia and Gastric Bleeding: Case Report and Review of the Literature. Healthcare (Basel) 2021; 9:healthcare9050540. [PMID: 34066323 PMCID: PMC8148137 DOI: 10.3390/healthcare9050540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/16/2021] [Accepted: 04/23/2021] [Indexed: 12/28/2022] Open
Abstract
Mucinous cystic neoplasms of the pancreas are uncommon and especially their occurrence during pregnancy is an extremely rare event which necessitates an individualized and interdisciplinary management. A 33-year old woman was referred to our department during her third trimester of pregnancy (34th week of gestation) with severe anemia and tarry stools. Based on gastroscopic findings, our interdisciplinary team suspected a gastrointestinal stromal tumor and therefore indicated a prompt delivery via cesarean section completed with an oncological resection of the neoplasm. Histological examination subsequently showed a mucinous cystic neoplasm of the pancreas with no evidence of malignancy. To review the prevalence of mucinous cystic neoplasms and to discuss diagnosis and treatment during pregnancy. Moreover, we critically value the indication of preterm delivery and the oncological procedure in the perspective of outcome for mother and infant. A bleeding gastrointestinal tumor during pregnancy represents a life-threatening risk for mother and infant and requires an immediate interdisciplinary treatment. The urgency and radicality of the therapy should be adapted according to individual findings. As our patient's tumor was suspected of having a malignant progression, an extensive surgical intervention was necessary.
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Affiliation(s)
- Susan Farahmandi
- Department of Gynecology and Obstetrics, Campus Kiel, University Medical Center UKSH, Arnold-Heller-Straße 3, Haus C, 24105 Kiel, Germany; (S.F.); (M.E.); (D.O.B.); (U.P.); (T.H.); (A.-L.R.); (N.M.); (P.J.)
| | - Mohamed Elessawy
- Department of Gynecology and Obstetrics, Campus Kiel, University Medical Center UKSH, Arnold-Heller-Straße 3, Haus C, 24105 Kiel, Germany; (S.F.); (M.E.); (D.O.B.); (U.P.); (T.H.); (A.-L.R.); (N.M.); (P.J.)
| | - Dirk O. Bauerschlag
- Department of Gynecology and Obstetrics, Campus Kiel, University Medical Center UKSH, Arnold-Heller-Straße 3, Haus C, 24105 Kiel, Germany; (S.F.); (M.E.); (D.O.B.); (U.P.); (T.H.); (A.-L.R.); (N.M.); (P.J.)
| | - Ulrich Pecks
- Department of Gynecology and Obstetrics, Campus Kiel, University Medical Center UKSH, Arnold-Heller-Straße 3, Haus C, 24105 Kiel, Germany; (S.F.); (M.E.); (D.O.B.); (U.P.); (T.H.); (A.-L.R.); (N.M.); (P.J.)
| | - Samir Abdullazade
- Department of Pathology, Campus Kiel, University Medical Center UKSH, Arnold-Heller-Straße 3, Haus U33, 24105 Kiel, Germany;
| | - Jan Henrik Beckmann
- Department of General, Abdominal, Thoracic, Transplantation and Pediatric Surgery, Campus Kiel, University Medical Center UKSH, Arnold-Heller-Straße 3, Haus U33, 24105 Kiel, Germany;
| | - Thorsten Heilmann
- Department of Gynecology and Obstetrics, Campus Kiel, University Medical Center UKSH, Arnold-Heller-Straße 3, Haus C, 24105 Kiel, Germany; (S.F.); (M.E.); (D.O.B.); (U.P.); (T.H.); (A.-L.R.); (N.M.); (P.J.)
| | - Anna-Lena Rumpf
- Department of Gynecology and Obstetrics, Campus Kiel, University Medical Center UKSH, Arnold-Heller-Straße 3, Haus C, 24105 Kiel, Germany; (S.F.); (M.E.); (D.O.B.); (U.P.); (T.H.); (A.-L.R.); (N.M.); (P.J.)
| | - Nicolai Maass
- Department of Gynecology and Obstetrics, Campus Kiel, University Medical Center UKSH, Arnold-Heller-Straße 3, Haus C, 24105 Kiel, Germany; (S.F.); (M.E.); (D.O.B.); (U.P.); (T.H.); (A.-L.R.); (N.M.); (P.J.)
| | - Peer Jansen
- Department of Gynecology and Obstetrics, Campus Kiel, University Medical Center UKSH, Arnold-Heller-Straße 3, Haus C, 24105 Kiel, Germany; (S.F.); (M.E.); (D.O.B.); (U.P.); (T.H.); (A.-L.R.); (N.M.); (P.J.)
| | - Vincent Winkler
- Department of Gynecology and Obstetrics, Campus Kiel, University Medical Center UKSH, Arnold-Heller-Straße 3, Haus C, 24105 Kiel, Germany; (S.F.); (M.E.); (D.O.B.); (U.P.); (T.H.); (A.-L.R.); (N.M.); (P.J.)
- Correspondence: ; Tel.: +49-431-500-21401
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13
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Keane MG, Afghani E. A Review of the Diagnosis and Management of Premalignant Pancreatic Cystic Lesions. J Clin Med 2021; 10:1284. [PMID: 33808853 PMCID: PMC8003622 DOI: 10.3390/jcm10061284] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 12/12/2022] Open
Abstract
Pancreatic cystic lesions are an increasingly common clinical finding. They represent a heterogeneous group of lesions that include two of the three known precursors of pancreatic cancer, intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms (MCN). Given that approximately 8% of pancreatic cancers arise from these lesions, careful surveillance and timely surgery offers an opportunity for early curative resection in a disease with a dismal prognosis. This review summarizes the current evidence and guidelines for the diagnosis and management of IPMN/MCN. Current pre-operative diagnostic tests in pancreatic cysts are imperfect and a proportion of patients continue to undergo unnecessary surgical resection annually. Balancing cancer prevention while preventing surgical overtreatment, continues to be challenging when managing pancreatic cysts. Cyst fluid molecular markers, such as KRAS, GNAS, VHL, PIK3CA, SMAD4 and TP53, as well as emerging endoscopic technologies such as needle-based confocal laser endomicroscopy and through the needle microbiopsy forceps demonstrate improved diagnostic accuracy. Differences in management and areas of uncertainty between the guidelines are also discussed, including indications for surgery, surveillance protocols and if and when surveillance can be discontinued.
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Affiliation(s)
| | - Elham Afghani
- Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA;
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14
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Revoredo F, de Vinatea J, Reaño G, Villanueva L, Kometter F, Arenas J, Polanco PM. Mucinous cystic neoplasms of the pancreas associated with pregnancy: Two case reports. Medicine (Baltimore) 2020; 99:e21471. [PMID: 32756169 PMCID: PMC7402798 DOI: 10.1097/md.0000000000021471] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
RATIONALE Although rare, pancreatic neoplasms can occur during pregnancy, both in benign and malignant forms. Mucinous cystic neoplasms (MCNs) of the pancreas, a type of these neoplasms, are precursor lesions to invasive pancreatic cancer. The presence of the ovarian-type stroma is a defining feature. PATIENT CONCERNS The first case was a 38-year-old woman in her 18th week of pregnancy with abdominal pain that worsens a few weeks later. The second case was a 30-year-old woman in her 17th week of pregnancy with abdominal pain in the left hypochondrium. DIAGNOSIS The patients were under clinical examination and laboratory test including carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA). Both patients had magnetic resonance imaging (MRI). The diagnosis of a MCNs of the pancreas was done preoperatively in the 2 cases. INTERVENTIONS Both patients underwent distal pancreatectomy during pregnancy. One of them was an emergency laparotomy because of a ruptured MCN. OUTCOMES Both patients were completely recovered from distal pancreatectomy and continued to full term, delivering a healthy baby by Caesarean section. After 6 years of follow-up, the first patient underwent a total gastrectomy, because of a gastric cancer with carcinomatosis. Currently the 2 patients are still alive after 8 years and 5 years of follow-up, respectively. LESSONS Surgical resection of MCNs during pregnancy should be considered during the second trimester given common distal pancreas location, rapid growth, risk of spontaneous rupture, and malignant potential.
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Affiliation(s)
| | | | | | | | | | - José Arenas
- Department of Pathology, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú
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15
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Management of Incidental Pancreatic Cystic Lesions: Integrating Novel Diagnostic and Prognostic Factors With Current Clinical Guidelines. J Clin Gastroenterol 2020; 54:415-427. [PMID: 32011401 DOI: 10.1097/mcg.0000000000001310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Owing to increased detection rates, the diagnosis and management of incidental pancreatic cysts has become a common predicament. Up to 13% of patients undergoing cross-sectional imaging studies for other indications are found to have pancreatic cystic lesions. Although most cystic lesions are benign, the malignant potential of several types of pancreatic cysts makes accurate classification vital to directing therapy. To this end, advances in the last decade led to better characterization of pancreatic cyst morphology and hence enhanced the ability to predict underlying histopathology, and biological behavior. Although accurate classification remains a challenge, the utilization of complementary diagnostic tools is the optimal approach to dictate management. The following review includes a description of pancreatic cysts, a critical review of current and emerging diagnostic techniques and a review of recent guidelines in the management of incidental pancreatic cysts.
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16
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Din NU, Zubair M, Abdul-Ghafar J, Ahmad Z. Pancreatic mucinous cystic neoplasms: a clinicopathological study of 11 cases and detailed review of literature. SURGICAL AND EXPERIMENTAL PATHOLOGY 2020. [DOI: 10.1186/s42047-020-0059-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Abstract
Background
Mucinous cystic neoplasms (MCNs) of pancreas are relatively rare, occur almost exclusively in middle-aged females, and are overwhelmingly located in the body and tail of the pancreas, histologically show an ovarian type stroma. MCNs are premalignant, low aggressive tumors. Here we describe the clinicopathologic and radiologic features and follow up of cases diagnosed in our practice. We also present a detailed review of recent literature.
Materials and methods
Based on strict criteria, 11 cases diagnosed between 2002 and 2016 were included in the study.
Results
All cases were reviewed histologically. Mean and median age was 46.7 and 46 years respectively. All patients were females and 9 out of 11 cases were located in the body and/or tail of the pancreas. Mean tumor size was 8 cm. Grossly, cysts were uni or multilocular and ranged from a few millimeters to several centimeters in diameter. Microscopically, all cases showed characteristic tall columnar, mucin producing epithelium and ovarian type stroma. Atypia was mild in 8 cases and severe in 3 cases. The latter 3 cases were classified as non-invasive MCNs with high grade dysplasia (2 cases) and MCN with an associated invasive carcinoma (1 case). On immunohistochemistry, all cases showed epithelial positivity for cytokeratin AE1/AE3 and stromal positivity for vimentin and smooth muscle actin. Follow up was available in 7 cases. All patients were alive and well with no recurrence.
Conclusions
Our cases show features similar to those described in other published studies although cases in our series tended to be larger in number. Since these tumors are relatively rare, premalignant and have strict diagnostic criteria, they must always be considered in the differential diagnosis of pancreatic mucinous cystic lesions. Larger studies incorporating greater number of patients and more detailed follow up will help in increasing our understanding of MCNs.
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Nicolas CT, Al Diffalha S, Reddy S. Diffuse histology-proven mucinous cystic neoplasm of the pancreas: A case report and review of literature. Int J Surg Case Rep 2019; 64:123-127. [PMID: 31634784 PMCID: PMC6806458 DOI: 10.1016/j.ijscr.2019.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/01/2019] [Accepted: 10/05/2019] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Mucinous cystic neoplasms (MCN) are rare premalignant neoplasms of the pancreas that are typically found as single lesions in the pancreatic body and tail of women in the fifth and sixth decade of life, do not communicate with the pancreatic ductal system and are characterized by mucin-producing epithelium supported by ovarian-type stroma. PRESENTATION OF CASE We present here a case of diffuse pancreatic involvement by MCN in a 64-year-old woman with chronic pancreatitis. Pre-operative suspicion for MCN was low due to the multi-centric nature of the lesions and imaging/biochemical fluid analysis demonstrating connection with the pancreatic ductal architecture. The patient underwent total pancreatectomy with pathology showing multiple cysts lined by flat epithelium with focal ovarian-type stroma, consistent with low-grade MCN. DISCUSSION The presence of ovarian stroma on histological analysis is one of the defining characteristics of MCNs per WHO guidelines, and is mandatory for its diagnosis. Only one case of diffuse MCN has been previously described in the literature; however, in this case the authors were not able to reach a definitive histological diagnosis based on WHO criteria. CONCLUSION To our knowledge, this is the first report of diffuse histology-proven MCN of the pancreas.
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Affiliation(s)
- Clara T Nicolas
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sameer Al Diffalha
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sushanth Reddy
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, United States.
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18
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Natural History and Treatment Trends in Pancreatic Cancer Subtypes. J Gastrointest Surg 2019; 23:768-778. [PMID: 30706376 DOI: 10.1007/s11605-019-04113-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 01/07/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND While pancreatic ductal adenocarcinoma is the most common form of pancreatic cancer, many other histologic forms of pancreatic cancer are also recognized. These histologic variants portray unique characteristics in terms of patient demographics, tumor behavior, survival, and responsiveness to treatments. MATERIALS AND METHODS Patients who underwent surgical resection of the pancreas for non-metastatic, invasive pancreatic cancer between 2004 and 2014 were selected from the National Cancer Data Base and categorized by histologic variant according to WHO classification guidelines. Patient demographics, tumor variables, treatment characteristics, and survival were compared between histologic groups and subgroups. RESULTS A total of 57,804 patients met inclusion and exclusion criteria and were grouped into eight major histologic categories. Survival analysis by the histologic group showed median overall survival of 20.2 months for ductal adenocarcinoma, 20.5 months for squamous cell carcinoma, 26.8 months for mixed acinar-neuroendocrine carcinomas, 52.6 months for cystic mucinous neoplasms with an associated invasive carcinoma, 67.5 months for acinar cell carcinoma, and 69.3 months for mesenchymal tumors. Median survival was not reached for neuroendocrine tumors and solid-pseudopapillary neoplasms, with 5-year overall survival rates of 84% and 97% respectively. CONCLUSIONS Rare subtypes of pancreatic cancer present unique clinicopathologic characteristics and display distinct tumor biologies. This study presents data on demographic, prognostic, treatment, and survival outcomes between rare forms of pancreatic neoplasms in order to aid understanding of the natural history and behavior of these neoplasms, with the hope of serving as a reference in clinical decision-making and ability to provide accurate prognostic information to patients.
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19
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Gurzu S, Bara T, Molnar C, Bara T, Butiurca V, Beres H, Savoji S, Jung I. The epithelial-mesenchymal transition induces aggressivity of mucinous cystic neoplasm of the pancreas with neuroendocrine component: An immunohistochemistry study. Pathol Res Pract 2019; 215:82-89. [PMID: 30391209 DOI: 10.1016/j.prp.2018.10.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 09/25/2018] [Accepted: 10/19/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pancreatic mucinous cystic neoplasms (MCN) are rare tumors that are usually diagnosed in females. MATERIALS AND METHODS In our department, only four of the 109 consecutive cases of pancreatic tumors (3.67%) were diagnosed as MCNs. In this report, we present the characteristics of these four specific cases which also showed unusual HER-2 positivity and neuroendocrine differentiation. RESULTS The four MCNs were diagnosed in patients with ages between 46 and 75 years. Other clinical particularities were the following: one benign case, splenic rupture as result of a giant cystic tumor on the tail of the pancreas directly invading the spleen in the second one, metastases in the accessory spleen in the third one and invasion of the abdominal vessels in the fourth case. In all of these cases, the ovarian-like stroma tested positivity for calretinin, progesterone receptor (PR) and, in cases 2 and 3, for AE1/AE3 keratin. The malignant tumor cells were marked by carcinoembryonic antigen, HER-2, maspin, PR and the neuroendocrine markers synaptophysin, CD56, and neuron-specific enolase. CONCLUSIONS These cases highlight the unusually aggressive behavior of pancreatic MCN with invasive carcinomas that share mixed exo- and endocrine components and show epithelial-mesenchymal transition.
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Affiliation(s)
- Simona Gurzu
- Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania; Department of Pathology, CCAMF - Research Center, Targu Mures, Romania; Department of Pathology, Clinical County Emergency Hospital, Targu Mures, Romania.
| | - Tivadar Bara
- Department of Surgery, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
| | - Calin Molnar
- Department of Surgery, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
| | - Tivadar Bara
- Department of Surgery, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
| | - Vlad Butiurca
- Department of Surgery, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
| | - Hanga Beres
- Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
| | - Simin Savoji
- Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
| | - Ioan Jung
- Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
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20
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Berevoescu N, Scăunașu R, Berevoescu M, Croitoru A. Mucinous cystadenoma of the pancreas associated with pregnancy. Case report and review of the literature. JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2018. [DOI: 10.25083/2559.5555/3.2/88.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective. We present a rare pathology with uncommon onset. Background. Mucinous cystic pancreatic neoplasms (MCNs) are rare tumors, which generally occur in the fifth and sixth decades of women. Although some tumours are frankly malignant, all are in fact considered to be potentially malignant. Case report. We present the case of a 30-year-old patient, with a 16/11 cm tumor located in the pancreas body, which was diagnosed 8 months after birth. The preoperative assessment of the pancreatic lesion suggested the diagnosis of mucosal cyst neoplasm, without being able to determine its benign or malignant nature. Central pancreatectomy was performed with a good postoperative evolution. Histopathologic result was represented by mucinous pancreatic chistadenoma. Two years after surgical intervention, the patient presented no signs of recurrence or pancreatic (exocrine or endocrine) secretion deficiency. Conclusions. Preoperative imaging evaluation could be suggestive for mucinous cystic tumour, but this cannot specify however the nature of the tumor. The postpartum occurrence could establish a possible relationship between hormonal levels encountered during pregnancy and the development of this tumor, taking into considerations the ovarian-type stroma and the presence of hormone (estrogen and progesterone) receptors in this neoplasm. Central pancreatectomy without anastomosis preserves the functions of pancreas, and also decreases morbidity.
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21
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Elias KM, Tsantoulis P, Tille JC, Vitonis A, Doyle LA, Hornick JL, Kaya G, Barnes L, Cramer DW, Puppa G, Stuckelberger S, Hooda J, Dietrich PY, Goggins M, Kerr CL, Birrer M, Hirsch MS, Drapkin R, Labidi-Galy SI. Primordial germ cells as a potential shared cell of origin for mucinous cystic neoplasms of the pancreas and mucinous ovarian tumors. J Pathol 2018; 246:459-469. [PMID: 30229909 DOI: 10.1002/path.5161] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 08/13/2018] [Accepted: 08/25/2018] [Indexed: 12/17/2022]
Abstract
Mucinous ovarian tumors (MOTs) morphologically and epidemiologically resemble mucinous cystic neoplasms (MCNs) of the pancreas, sharing a similar stroma and both occurring disproportionately among young females. Additionally, MOTs and MCNs share similar clinical characteristics and immunohistochemical phenotypes. Exome sequencing has revealed frequent recurrent mutations in KRAS and RNF43 in both MOTs and MCNs. The cell of origin for these tumors remains unclear, but MOTs sometimes arise in the context of mature cystic teratomas and other primordial germ cell (PGC) tumors. We undertook the present study to investigate whether non-teratoma-associated MOTs and MCNs share a common cell of origin. Comparisons of the gene expression profiles of MOTs [including both the mucinous borderline ovarian tumors (MBOTs) and invasive mucinous ovarian carcinomas (MOCs)], high-grade serous ovarian carcinomas, ovarian surface epithelium, Fallopian tube epithelium, normal pancreatic tissue, pancreatic duct adenocarcinomas, MCNs, and single-cell RNA-sequencing of PGCs revealed that both MOTs and MCNs are more closely related to PGCs than to either eutopic epithelial tumors or normal epithelia. We hypothesize that MCNs may arise from PGCs that stopped in the dorsal pancreas during their descent to the gonads during early human embryogenesis, while MOTs arise from PGCs in the ovary. Together, these data suggest a common pathway for the development of MCNs and MOTs, and suggest that these tumors may be more properly classified as germ cell tumor variants. Copyright © 2018 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Kevin M Elias
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA.,Division of Gynecologic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Petros Tsantoulis
- Department of internal medicine specialties, Facutly of Medicine, Université de Genève, Geneva, Switzerland.,Department of Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | | | - Allison Vitonis
- Department of Obstetrics and Gynecology, Epidemiology Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Leona A Doyle
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Jason L Hornick
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Gurkan Kaya
- Department of internal medicine specialties, Facutly of Medicine, Université de Genève, Geneva, Switzerland.,Division of Dermatology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Laurent Barnes
- Division of Dermatology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Daniel W Cramer
- Harvard Medical School, Boston, MA, USA.,Department of Obstetrics and Gynecology, Epidemiology Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Giacomo Puppa
- Division of Pathology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Sarah Stuckelberger
- Penn Ovarian Cancer Research Center, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA
| | - Jagmohan Hooda
- Penn Ovarian Cancer Research Center, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA
| | - Pierre-Yves Dietrich
- Department of internal medicine specialties, Facutly of Medicine, Université de Genève, Geneva, Switzerland.,Department of Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Michael Goggins
- Department of Pathology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Candace L Kerr
- Department of Biochemistry and Molecular Biology, University of Maryland, Baltimore, MD, USA
| | - Michael Birrer
- Division of Hematology-Oncology, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL, USA
| | - Michelle S Hirsch
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Ronny Drapkin
- Penn Ovarian Cancer Research Center, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA
| | - Sana Intidhar Labidi-Galy
- Department of internal medicine specialties, Facutly of Medicine, Université de Genève, Geneva, Switzerland.,Department of Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
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22
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An Array of Bioactive Compounds From Australian Eucalypts and Their Relevance in Pancreatic Cancer Therapeutics. Pancreas 2018; 47:690-707. [PMID: 29894418 DOI: 10.1097/mpa.0000000000001074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Pancreatic cancer (PC) is one of the most devastating human cancers, and despite the significant advances in the current therapeutic options, the overall survival rate for PC has remained static for the past 50 years. Plant-derived bioactive compounds play a vital role in cancer therapeutics by providing new lead compounds for future drug development. Therefore, the isolation, characterization, and identification of new bioactive compounds for the prevention and treatment of cancer continue to be an important aspect of natural product research. Many in vitro and in vivo studies published in the last few decades have established strong links between the phytochemical profile of eucalypts and anticancer activity. However, only a small number of these reports have attempted to demonstrate a relationship between the biological activity of eucalypt extracts and PC. This review focuses on potential anti-PC effects of an array of bioactive compounds present in various species of eucalypts. It also highlights the necessity for further in vitro and in vivo studies to develop a complete understanding of the potential this group of plants has for the development of potent and specific chemotherapeutic drugs for PC.
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23
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Hui L, Rashid A, Foo WC, Katz MH, Chatterjee D, Wang H, Fleming JB, Tamm EP, Wang H. Significance of T1a and T1b Carcinoma Arising in Mucinous Cystic Neoplasm of Pancreas. Am J Surg Pathol 2018; 42:578-586. [PMID: 29462092 PMCID: PMC5893396 DOI: 10.1097/pas.0000000000001040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Mucinous cystic neoplasm (MCN) of pancreas is one of the precursor lesions of pancreatic ductal adenocarcinoma. The 5-year disease-specific survival for noninvasive MCNs was 100% and 20% to 60% for those with pancreatic ductal adenocarcinoma arising in a MCN. However, the significance of T1a (≤0.5 cm) and T1b (>0.5 and <1.0 cm) carcinoma arising in MCN as defined by the upcoming American Joint Committee on Cancer, eighth edition is unclear. In this study, we examined 3 cases of MCN with T1a or T1b carcinoma and compared their clinicopathologic characteristics and survival to 46 cases of MCN with low-grade dysplasia (MCN-LGD), 7 cases of MCN with high-grade dysplasia (MCN-HGD), and 7 cases of MCN with advanced invasive carcinoma (T2 or higher T stage). The tumors from all 3 cases were submitted in their entirety in 123, 296, and 200 blocks, respectively. All 3 patients were alive with no recurrence during the follow-up of 20.0, 113.8, and 137.2 months, respectively. Similarly, none of the patients who had MCN with either LGD or HGD had recurrence or died of disease. In contrast, 5 of 7 patients who had MCN with advanced invasive carcinoma had recurrence and later died of disease with a median survival of 22.9 months (P<0.001). Our study showed that MCN with T1a and T1b carcinoma had an excellent prognosis similar to MCNs with LGD or HGD after complete tumor sampling for histologic examination. Our results along with the previous studies suggest that close follow-up, rather than aggressive systemic therapy, may be a better approach for these patients.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biopsy
- Carcinoma, Pancreatic Ductal/mortality
- Carcinoma, Pancreatic Ductal/pathology
- Carcinoma, Pancreatic Ductal/surgery
- Databases, Factual
- Female
- Humans
- Male
- Middle Aged
- Neoplasm Grading
- Neoplasm Staging
- Neoplasms, Cystic, Mucinous, and Serous/mortality
- Neoplasms, Cystic, Mucinous, and Serous/pathology
- Neoplasms, Cystic, Mucinous, and Serous/surgery
- Pancreatectomy
- Pancreatic Neoplasms/mortality
- Pancreatic Neoplasms/pathology
- Pancreatic Neoplasms/surgery
- Pancreaticoduodenectomy
- Predictive Value of Tests
- Risk Factors
- Time Factors
- Tomography, X-Ray Computed
- Treatment Outcome
- Tumor Burden
- Young Adult
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Affiliation(s)
| | | | | | | | | | - Hua Wang
- Gastrointestinal Medical Oncology
| | | | - Eric P Tamm
- Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX
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24
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El Gammal AT, Izbicki JR. Incidental Intraductal Papillary Mucinous Neoplasm, Cystic or Premalignant Lesions of the Pancreas. Surg Clin North Am 2018; 98:141-155. [DOI: 10.1016/j.suc.2017.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Moutinho-Ribeiro P, Coelho R, Giovannini M, Macedo G. Pancreatic cancer screening: Still a delusion? Pancreatology 2017; 17:754-765. [PMID: 28739291 DOI: 10.1016/j.pan.2017.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 06/17/2017] [Accepted: 07/05/2017] [Indexed: 12/11/2022]
Abstract
Pancreatic adenocarcinoma represents the fourth most common cause of cancer mortality and death due to pancreatic cancer (PC) have increased since 2003. Its incidence has also raised about 30% in the past decade and it is expected to become the second cause of cancer mortality by 2020 in the USA. Most PC present with metastatic disease and improvements in treatment outcomes for this group have been disappointing. These observations support the idea that screening to identify patients at an earlier stage might be an important strategy in improving overall PC outcomes. Many protocols have been tested, nevertheless, by now there is no effective screening program. Given the overall low incidence of disease and the current lack of accurate, inexpensive and noninvasive screening tests, the consensus is that widespread population-based screening for PC in the general population or in patients with only one affected first-degree relative is neither practicable nor indicated in most countries. However, a different scenario is screening patients with higher risk for PC, most of them with hereditary conditions predisposing the development of this neoplasia. In fact, some guidelines are now available helping to select these individuals at risk and to screen them, in order to achieve early detection of PC.
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Affiliation(s)
- Pedro Moutinho-Ribeiro
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal; Faculty of Medicine, University of Porto, Portugal.
| | - Rosa Coelho
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal
| | - Marc Giovannini
- Endoscopic Unit, Paoli-Calmettes Institute, Marseilles, France
| | - Guilherme Macedo
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal; Faculty of Medicine, University of Porto, Portugal
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Holloman C, Carlan SJ, Sundharkrishnan L, Guzman A, Madruga M. Successful pregnancy after mucinous cystic neoplasm with invasive carcinoma of the pancreas in a patient with polycystic ovarian syndrome: a case report. J Med Case Rep 2017; 11:188. [PMID: 28693619 PMCID: PMC5504786 DOI: 10.1186/s13256-017-1343-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 05/15/2017] [Indexed: 11/21/2022] Open
Abstract
Background The incidence of invasive cancer within a mucinous cystic neoplasm of the pancreas varies between 6 and 36%. Polycystic ovarian syndrome is a disorder characterized by hyperandrogenism and anovulatory infertility. One surgical treatment that can restore endocrine balance and ovulation in polycystic ovarian syndrome is partial ovarian destruction. Successful pregnancies following preconception pancreaticoduodenectomies (Whipple procedures) and chemoradiation to treat pancreatic neoplasms have been reported rarely but none were diagnosed with pre-cancer polycystic ovarian syndrome-associated infertility. Gemcitabine is an antimetabolite drug used for the treatment of pancreatic cancer that can have profound detrimental effects on oogenesis and ovarian function. Whether the ovarian destructive property of gemcitabine could act as a method to restore ovulation potential in polycystic ovarian syndrome is unknown. Case presentation A 40-year-old white American woman with a history of pancreatic cancer treatment with a Whipple procedure and chemoradiation with gemcitabine had a successful pregnancy after years of pre-cancerous anovulatory infertility and polycystic ovarian syndrome. She received no fertility agents and delivered full term via a spontaneous vaginal delivery with no pregnancy complications. Conclusion Gemcitabine treatment for pancreatic cancer may result in resumption of ovulation in women with polycystic ovarian syndrome and these women should be counseled accordingly.
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Affiliation(s)
- Conisha Holloman
- Department of Obstetrics and Gynecology, Orlando Regional Healthcare, 1401 Lucerne Terrace, 2nd floor, Orlando, Fl, 32806, USA
| | - S J Carlan
- Department of Obstetrics and Gynecology, Orlando Regional Healthcare, 1401 Lucerne Terrace, 2nd floor, Orlando, Fl, 32806, USA.
| | | | - Angela Guzman
- Department of Obstetrics and Gynecology, Orlando Regional Healthcare, 1401 Lucerne Terrace, 2nd floor, Orlando, Fl, 32806, USA
| | - Mario Madruga
- Department of Medicine, Orlando Regional Healthcare, Orlando, FL, USA
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Khamaysi I, Abu Ammar A, Vasilyev G, Arinstein A, Chowers Y, Zussman E. Differentiation of Pancreatic Cyst Types by Analysis of Rheological Behavior of Pancreatic Cyst Fluid. Sci Rep 2017; 7:45589. [PMID: 28358122 PMCID: PMC5372360 DOI: 10.1038/srep45589] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 02/27/2017] [Indexed: 12/18/2022] Open
Abstract
Differentiation between mucinous and non-mucinous pancreatic cysts is exceedingly important and challenging, particularly as the former bears malignant transformation potential. Pancreatic cyst fluid (PCF)-based diagnostics, including analyses of biochemical markers, as well as cytology, has shown inadequate accuracy. Herein, a preliminary single-center study of 22 PCF samples, collected by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), assessed the rheological behavior of PCF and its correlation with lesion type. The dependence of PCF shear viscosity on shear rate was found to follow a power law and could be fitted using Ostwald-de Waele model. Three types of flow curves were identified, where two types correlated with non-mucinous cysts, differing by their power law exponent, and the third type corresponding to mucinous cysts. Viscosity measured at a high shear rate was shown to serve as an accurate and independent marker distinguishing between mucinous and non-mucinous cysts, with an optimal cutoff value of ηc = 1.3 cP The accuracy of this novel technique proved superior to string-sign, cytology, carcinoembryonic antigen, and amylase assessments. Moreover, the combined predictive value of ηc and patient age provided for sensitivity and specificity of 100% and 95.5%, respectively. This simple and rapid diagnostic tool can be immediately implemented after EUS-FNA sampling.
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Affiliation(s)
- Iyad Khamaysi
- Department of Gastroenterology, Bruce Rappaport Sch Med, Technion IIT, Haifa 32000, Israel
- Gastroenterology department, Rambam Health Care Campus, Haifa 31096, Israel
| | - Aiman Abu Ammar
- NanoEngineering Group, Faculty of Mechanical Engineering, Technion – IIT, Haifa 32000, Israel
| | - Gleb Vasilyev
- NanoEngineering Group, Faculty of Mechanical Engineering, Technion – IIT, Haifa 32000, Israel
| | - Arkadii Arinstein
- NanoEngineering Group, Faculty of Mechanical Engineering, Technion – IIT, Haifa 32000, Israel
| | - Yehuda Chowers
- Department of Gastroenterology, Bruce Rappaport Sch Med, Technion IIT, Haifa 32000, Israel
- Gastroenterology department, Rambam Health Care Campus, Haifa 31096, Israel
| | - Eyal Zussman
- NanoEngineering Group, Faculty of Mechanical Engineering, Technion – IIT, Haifa 32000, Israel
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Roch AM, Bigelow K, Schmidt CM, Carr RA, Jester AL, Ceppa EP, House MG, Zyromski NJ, Nakeeb A, Schmidt CM. Management of Undifferentiated Solitary Mucinous Cystic Lesion of the Pancreas: A Clinical Dilemma. J Am Coll Surg 2017; 224:717-723. [PMID: 28126546 DOI: 10.1016/j.jamcollsurg.2016.12.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 12/22/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Management of solitary mucinous cystic lesions of the pancreas (MCLs) relies on correct differentiation between branch duct intraductal papillary mucinous neoplasm (BD-IPMN) and mucinous cystic neoplasm (MCN). Current international consensus guidelines recommend resection for MCN, and unifocal BD-IPMN can be followed in the absence of worrisome features/high-risk stigmata. We hypothesized that preoperative differentiation of solitary MCLs is suboptimal, and that all solitary MCLs should be treated similarly. STUDY DESIGN A retrospective review of an institutional database (2003 to 2016) identified 711 patients who underwent resection for pancreatic cyst. Only lesions that met cytologic or biochemical criteria for diagnosis of MCLs were included. Mucinous cystic neoplasms were defined by presence of ovarian stroma on pathology. Patients with formal preoperative diagnosis of BD-IPMN (multifocality, GNAS mutation) were excluded. RESULTS One hundred and eighty solitary MCLs were identified on preoperative imaging (mean age 54 years, 24% men). On surgical pathology, 108 were MCNs and 72 BD-IPMNs. There was no difference in invasive rate (7 of 108 [6.5%] MCNs vs 4 of 72 [5.6%] BD-IPMN; p ≈ 1). Pancreatic ductal connectivity was reported on imaging/endoscopy in 10 of 108 (9%) MCNs and 22 of 72 (31%) BD-IPMNs, representing 67% accuracy in differentiating MCNs from BD-IPMNs. On multivariate analysis, typical risk factors failed to predict invasiveness in either MCNs or BD-IPMNs. When all undifferentiated solitary MCLs were analyzed together, older age (p = 0.03) and cyst size (p = 0.04) were associated with increased invasive rate in multivariate analysis. CONCLUSIONS Unreliable differentiation and limited ability to predict invasiveness make solitary MCLs clinically challenging. With similar invasive rates, MCN and unifocal BD-IPMNs should be merged into one new entity for management, the undifferentiated solitary MCL.
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Affiliation(s)
- Alexandra M Roch
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Katherine Bigelow
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Christian M Schmidt
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Rosalie A Carr
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Andrea L Jester
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Eugene P Ceppa
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Michael G House
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Nicholas J Zyromski
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Attila Nakeeb
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - C Max Schmidt
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
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Nilsson LN, Keane MG, Shamali A, Millastre Bocos J, Marijinissen van Zanten M, Antila A, Verdejo Gil C, Del Chiaro M, Laukkarinen J. Nature and management of pancreatic mucinous cystic neoplasm (MCN): A systematic review of the literature. Pancreatology 2016; 16:1028-1036. [PMID: 27681503 DOI: 10.1016/j.pan.2016.09.011] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 09/17/2016] [Accepted: 09/20/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The current management of pancreatic mucinous cystic neoplasms (MCN) is defined by the consensus European, International Association of Pancreatology and American College of Gastroenterology guidelines. However, the criterion for surgical resection remains uncertain and differs between these guidelines. Therefore through this systematic review of the existing literature we aimed to better define the natural history and prognosis of these lesions, in order to clarify recommendations for future management. METHODS A systematic literature search was performed (PubMed, EMBASE, Cochrane Library) for studies published in the English language between 1970 and 2015. RESULTS MCNs occur almost exclusively in women (female:male 20:1) and are mainly located in the pancreatic body or tail (93-95%). They are usually found incidentally at the age of 40-60 years. Cross-sectional imaging and endoscopic ultrasound are the most frequently used diagnostic tools, but often it is impossible to differentiate MCNs from branch duct intraductal papillary mucinous neoplasms (BD-IPMN) or oligocystic serous adenomas pre-operatively. In resected MCNs, 0-34% are malignant, but in those less than 4 cm only 0.03% were associated with invasive adenocarcinoma. No surgically resected benign MCNs were associated with a synchronous lesion or recurrence; therefore further follow-up is not required after resection. Five-year survival after surgical resection of a malignant MCN is approximately 60%. CONCLUSIONS Compared to other pancreatic tumors, MCNs have a low aggressive behavior, with exceptionally low rates of malignant transformation when less than 4 cm in size, are asymptomatic and lack worrisome features on pre-operative imaging. This differs significantly from the natural history of small BD-IPMNs, supporting the need to differentiate mucinous cyst subtypes pre-operatively, where possible. The findings support the recommendations from the recent European Consensus Guidelines, for the more conservative management of MCNs.
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Affiliation(s)
| | - Margaret G Keane
- Institute for Liver and Digestive Health, University College London, UK
| | | | | | | | - Anne Antila
- Tampere University Hospital, Tampere, Finland
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Laparoscopic approach to distal pancreatectomy in pancreatic cystic neoplasms - report of three cases and literature review. Wideochir Inne Tech Maloinwazyjne 2015; 10:499-503. [PMID: 26649104 PMCID: PMC4653257 DOI: 10.5114/wiitm.2015.54058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 07/20/2015] [Accepted: 07/28/2015] [Indexed: 01/04/2023] Open
Abstract
The development of cross-section imaging increased the number of diagnosed pancreatic cystic neoplasms (PCNs). Many of these lesions, located frequently in the body or tail of the organ, require resection. We present three cases of patients undergoing laparoscopic distal pancreatectomy because of PCNs, describing the technique along with the post-operative course. The reviewed literature confirms the benefits of the laparoscopic approach, yet it lacks randomized, controlled trials. We also present two spleen-preserving surgical techniques – with and without ligation of the splenic vessels. Both of these procedures can be performed with laparoscopy or laparotomy, but there is no consensus which should be the method of choice.
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31
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Mauriello C, Napolitano S, Gambardella C, Candela G, De Vita F, Orditura M, Sciascia V, Tartaglia E, Lanza M, Santini L, Conzo G. Conservative management and parenchyma-sparing resections of pancreatic neuroendocrine tumors: Literature review. Int J Surg 2015; 21 Suppl 1:S10-4. [PMID: 26118605 DOI: 10.1016/j.ijsu.2015.04.089] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 03/23/2015] [Accepted: 04/10/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pancreatic neuroendocrine tumors (pNETs) are uncommon entities. pNETs are often small, slow growing, clinically silent neoplasms. However, they have an almost unpredictable biological behaviour with a not negligible malignant potential. Surgery still represents the treatment of choice, but the high morbidity associated to the enucleation or the formal pancreatectomy should be considered in the decision of the proper treatment. Management of these neoplasms is still debated, and indications for a conservative observational approach and for parenchyma sparing resections are not yet standardized. METHOD We review the state of art on the indications for the conservative management of pNETs. Searches on MEDLINE database were performed to identify articles reporting prognostic systems, biochemical screening, observational management, medical treatment and surgical strategies for pNETs. DISCUSSION Currently, an accurate 'wait-and-see' policy is recommended by the European Neuroendocrine Tumor Society (ENETS) only for non-functioning pNETs (NF-pNETs) <2 cm. A biochemical screening, based on sampling of serum levels of pancreatic polypeptide (PP) and chromogranin A, can address to early conservative surgery for MEN-1 associated NF-pNETs <2 cm to prevent their malignant transformation. The subtotal (80%) distal pancreatectomy first proposed by Thompson, often with the enucleation of possible pancreatic head tumors, still represents a good compromise between oncological radicality and prevention of pancreatic endocrine/exocrine insufficiency caused by standard radical resections for the treatment of inherited syndromes associated with NF-pNETs >2 cm and symptomatic F-pNETs of any size. CONCLUSION More studies are needed to further clarify and predict the biologic behaviour of pNETs and increase the indications for conservative observational management and parenchyma sparing pancreas resections.
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Affiliation(s)
- Claudio Mauriello
- Department of Anaesthesiologic, Surgical and Emergency Sciences, Unit of General and Oncologic Surgery, School of Medicine, Second University of Naples, Italy.
| | - Salvatore Napolitano
- Medical Officer, Italian Air Force Medical Corps, Ministry of Defence, Rome, Italy.
| | - Claudio Gambardella
- Department of Anaesthesiologic, Surgical and Emergency Sciences, Unit of General and Oncologic Surgery, School of Medicine, Second University of Naples, Italy.
| | - Giancarlo Candela
- Department of Anaesthesiologic, Surgical and Emergency Sciences, Unit of General and Oncologic Surgery, School of Medicine, Second University of Naples, Italy.
| | - Ferdinando De Vita
- Department of Clinical and Experimental Medicine, Divisions of Oncology, School of Medicine, Second University of Naples, Italy.
| | - Michele Orditura
- Department of Clinical and Experimental Medicine, Divisions of Oncology, School of Medicine, Second University of Naples, Italy.
| | - Valerio Sciascia
- Department of Anaesthesiologic, Surgical and Emergency Sciences, Unit of General and Oncologic Surgery, School of Medicine, Second University of Naples, Italy.
| | - Ernesto Tartaglia
- Department of Anaesthesiologic, Surgical and Emergency Sciences, Unit of General and Oncologic Surgery, School of Medicine, Second University of Naples, Italy.
| | - Michele Lanza
- Department of Anaesthesiologic, Surgical and Emergency Sciences, Unit of General and Oncologic Surgery, School of Medicine, Second University of Naples, Italy.
| | - Luigi Santini
- Department of Anaesthesiologic, Surgical and Emergency Sciences, Unit of General and Oncologic Surgery, School of Medicine, Second University of Naples, Italy.
| | - Giovanni Conzo
- Department of Anaesthesiologic, Surgical and Emergency Sciences, Unit of General and Oncologic Surgery, School of Medicine, Second University of Naples, Italy.
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Utomo WK, Braat H, Bruno MJ, van Eijck CHJ, Koerkamp BG, Krak NC, van de Vreede A, Fuhler GM, Peppelenbosch MP, Biermann K. Cytopathological Analysis of Cyst Fluid Enhances Diagnostic Accuracy of Mucinous Pancreatic Cystic Neoplasms. Medicine (Baltimore) 2015; 94:e988. [PMID: 26091476 PMCID: PMC4616542 DOI: 10.1097/md.0000000000000988] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Widespread use of cross-sectional imaging and increasing age of the general population has increased the number of detected pancreatic cystic lesions. However, several pathological entities with a variety in malignant potential have to be discriminated to allow clinical decision making. Discrimination between mucinous pancreatic cystic neoplasms (PCNs) and nonmucinous pancreatic lesions is the primary step in the clinical work-up, as malignant transformation is mostly associated with mucinous PCN. We performed a retrospective analysis of all resected PCN in our tertiary center from 2000 to 2014, to evaluate preoperative diagnostic performance and the results of implementation of the consensus guidelines over time. This was followed by a prospective cohort study of patients with an undefined pancreatic cyst, where the added value of cytopathological mucin evaluation to carcinoembryonic antigen (CEA) in cyst fluid for the discrimination of mucinous PCN and nonmucinous cysts was investigated. Retrospective analysis showed 115 patients operated for a PCN, with a correct preoperative classification in 96.2% of the patients. High-grade dysplasia or invasive carcinoma was observed in only 32.3% of mucinous PCN. In our prospective cohort (n = 71), 57.7% of patients were classified as having a mucinous PCN. CEA ≥ 192 ng/mL had an accuracy of 63.4%, and cytopathological mucin evaluation an accuracy of 73.0%. Combining these 2 tests further improved diagnostic accuracy of a mucinous PCN to 76.8%. CEA level and mucin evaluation were not predictive of the degree of dysplasia. These findings show that adding cytopathology to cyst fluid biochemistry improves discrimination between mucinous PCN and nonmucinous cysts.
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Affiliation(s)
- Wesley K Utomo
- From the Department of Gastroenterology and Hepatology (WKU, HB, MJB, AvDV, GMF, MPP); Department of Surgery (CHJvE, BGK); Department of Radiology (NCK); and Department of Pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands (KB)
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Li C, Lin X, Hui C, Lam KM, Zhang S. Computer-Aided Diagnosis for Distinguishing Pancreatic Mucinous Cystic Neoplasms From Serous Oligocystic Adenomas in Spectral CT Images. Technol Cancer Res Treat 2014; 15:44-54. [PMID: 25520271 DOI: 10.1177/1533034614563013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 11/10/2014] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE This preliminary study aims to verify the effectiveness of the additional information provided by spectral computed tomography (CT) with the proposed computer-aided diagnosis (CAD) scheme to differentiate pancreatic serous oligocystic adenomas (SOAs) from mucinous cystic neoplasms of pancreas cystic lesions. MATERIALS AND METHODS This study was conducted from January 2010 to October 2013. Twenty-three patients (5 men and 18 women; mean age, 43.96 years old) with SOA and 19 patients (3 men and 16 women; mean age, 41.74 years old) with MCN were included in this retrospective study. Two types of features were collected by dual-energy spectral CT imaging as follows: conventional and additional quantitative spectral CT features. Classification results of the CAD scheme were compared using the conventional features and full feature data set. Important features were selected using support vector machine classification method combined with feature-selection technique. The optimal cutoff values of selected features were determined through receiver-operating characteristic curve analyses. RESULTS Combining conventional features with additional spectral CT features improved the overall accuracy from 88.37% to 93.02%. The selected features of the proposed CAD scheme were tumor size, contour, location, and low-energy CT values (43 keV). Iodine-water basis material pair densities in both arterial phase (AP) and portal venous phase (PP) were important factors for differential diagnosis of SOA and MCN. The optimal cutoff values of long axis, short axis, 40 keV monochromatic CT value in AP, iodine (water) density in AP, 43 keV monochromatic CT value in PP, and iodine (water) density in PP were 3.4 mm, 3.1 mm, 35.7 Hu, 0.32533 mg/mL, 39.4 Hu, and 0.348 mg/mL, respectively. CONCLUSION The combination of conventional features and additional information provided by dual-energy spectral CT shows a high accuracy in the CAD scheme. The quantitative information of spectral CT may prove useful in the diagnosis and classification of SOAs and MCNs with machine learning algorithms.
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Affiliation(s)
- Chao Li
- Department of Biomedical Engineering, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaozhu Lin
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chun Hui
- Department of Biomedical Engineering, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Kin Man Lam
- Department of Electronic and Information Engineering, Centre for Signal Processing, the Hong Kong Polytechnic University, Hong Kong, China
| | - Su Zhang
- Department of Biomedical Engineering, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
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ZHANG BEIBEI, GUO XIAORONG, ZHANG JINGXI, LIU XIAO, ZHAN XIANBAO, LI ZHAOSHEN. MicroRNA-224 is downregulated in mucinous cystic neoplasms of the pancreas and may regulate tumorigenesis by targeting Jagged1. Mol Med Rep 2014; 10:3303-9. [DOI: 10.3892/mmr.2014.2658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 06/09/2014] [Indexed: 11/06/2022] Open
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35
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Ishikawa T, Haruta JI, Yamaguchi T, Doisaki M, Yama T, Murate K, Hattori S, Hayakawa F, Yamada K, Yashika J. A case of mucinous cystic neoplasm of the pancreas misdiagnosed as a pancreatic pseudocyst at the initial exam and resected after a 2-year follow-up. J Med Ultrason (2001) 2014; 42:257-65. [DOI: 10.1007/s10396-014-0581-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 09/08/2014] [Indexed: 10/24/2022]
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36
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Abstract
Surgical resection is recommended for all mucinous cystic neoplasms (MCNs) of the pancreas as a result of: 1) lack of an accurate tumor marker for invasive cancer; 2) young age at diagnosis; and 3) historical studies revealing 36 per cent incidence of malignancy in resected lesions. This study compares the clinicopathologic and prognostic features of our series of resected MCNs to recent studies using the current International Association of Pancreatology (IAP) system. Thirty-eight resected MCNs were identified. Almost all patients were female (97.4%); median age at diagnosis was 53.5 years (interquartile range [IQR], 41.3 to 61.0). The majority occurred in the body/tail of the pancreas (86.8%); median size on computed tomography/magnetic resonance imaging was 5.0 cm (IQR, 3 to 8.8). Comparison of the five high-grade (HG, 13.2%) and 33 low-grade (86.8%) MCNs revealed that 1) patients were similar in age (55.0 vs 52.0 years, respectively) and 2) HG lesions were significantly larger on preoperative imaging (9.9 vs 3.5 cm) and final pathology (10.9 vs 3.5 cm). These data, taken together with five recent studies that adhere to the 2012 IAP criteria (385 total MCNs), reveal that a cutoff of less than 3 cm without mural nodules would have only missed one (0.26%) HG lesion. Surveillance of these lesions may be appropriate for some patients.
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Magnetic resonance imaging of less common pancreatic malignancies and pancreatic tumors with malignant potential. Eur J Radiol Open 2014; 1:49-59. [PMID: 26937427 PMCID: PMC4750607 DOI: 10.1016/j.ejro.2014.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 09/16/2014] [Accepted: 09/17/2014] [Indexed: 02/07/2023] Open
Abstract
Pancreatic tumors are an increasingly common finding in abdominal imaging. Various kinds of pathologies of the pancreas are well known, but it often remains difficult to classify the lesions radiologically in respect of type and grade of malignancy. Magnetic resonance imaging (MRI) is the method of choice for the evaluation of pancreatic pathologies due to its superior soft tissue contrast. In this article we present a selection of less common malignant and potentially malignant pancreatic neoplasms with their characteristic appearance on established MRI sequences with and without contrast enhancement.
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Buscarini E, Pezzilli R, Cannizzaro R, De Angelis C, Gion M, Morana G, Zamboni G, Arcidiacono P, Balzano G, Barresi L, Basso D, Bocus P, Calculli L, Capurso G, Canzonieri V, Casadei R, Crippa S, D'Onofrio M, Frulloni L, Fusaroli P, Manfredi G, Pacchioni D, Pasquali C, Rocca R, Ventrucci M, Venturini S, Villanacci V, Zerbi A, Falconi M. Italian consensus guidelines for the diagnostic work-up and follow-up of cystic pancreatic neoplasms. Dig Liver Dis 2014; 46:479-93. [PMID: 24809235 DOI: 10.1016/j.dld.2013.12.019] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 12/07/2013] [Accepted: 12/30/2013] [Indexed: 12/11/2022]
Abstract
This report contains clinically oriented guidelines for the diagnostic work-up and follow-up of cystic pancreatic neoplasms in patients fit for treatment. The statements were elaborated by working groups of experts by searching and analysing the literature, and then underwent a consensus process using a modified Delphi procedure. The statements report recommendations regarding the most appropriate use and timing of various imaging techniques and of endoscopic ultrasound, the role of circulating and intracystic markers and the pathologic evaluation for the diagnosis and follow-up of cystic pancreatic neoplasms.
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Affiliation(s)
| | | | | | - Raffaele Pezzilli
- Pancreas Unit, Department of Digestive Diseases and Internal Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Claudio De Angelis
- Gastroenterology and Hepatology Department, A.O. San Giovanni Battista/Molinette, University of Turin, Turin, Italy
| | - Massimo Gion
- Department of Clinical Pathology, AULSS 12, Venice, Italy
| | - Giovanni Morana
- Department of Diagnostic Radiology, Ospedale Cà Foncello, Treviso, Italy
| | | | - Paolo Arcidiacono
- Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute, Italy
| | - Gianpaolo Balzano
- Department of Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Luca Barresi
- Gastroenterology and Endoscopy Unit, ISMETT, Palermo, Italy
| | - Daniela Basso
- Department of Laboratory Medicine, University Hospital, Padua, Italy
| | - Paolo Bocus
- Gastroenterology Unit, Ospedale Sacro Cuore-Don Calabria, Negrar, Verona, Italy
| | - Lucia Calculli
- Department of Radiology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Gabriele Capurso
- Digestive and Liver Disease Unit, Faculty of Medicine and Psychology, Sapienza University of Rome at S. Andrea Hospital, Rome, Italy
| | | | - Riccardo Casadei
- Department of Surgery, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Stefano Crippa
- Department of Surgery, Pancreas Unit, Università Politecnica delle Marche, Ancona, Italy
| | - Mirko D'Onofrio
- Department of Radiology, University Hospital G.B. Rossi, University of Verona, Verona, Italy
| | - Luca Frulloni
- Department of Surgical and Gastroenterological Sciences, University of Verona, Verona, Italy
| | - Pietro Fusaroli
- Department of Clinical Medicine, University of Bologna, Bologna, Italy
| | | | | | - Claudio Pasquali
- Surgery Unit IV, Department of Medical and Surgical Sciences, University of Padua, Padua, Italy
| | - Rodolfo Rocca
- Gastroenterology Unit, Mauriziano Hospital, Turin, Italy
| | - Maurizio Ventrucci
- Department of Internal Medicine and Gastroenterology, Bentivoglio Hospital, Bologna, Italy
| | - Silvia Venturini
- Department of Diagnostic Radiology, Ospedale Cà Foncello, Treviso, Italy
| | | | - Alessandro Zerbi
- Pancreatic Surgery, Department of Surgery, Humanitas Clinical and Research Center, Milan, Italy
| | - Massimo Falconi
- Department of Surgery, Pancreas Unit, Università Politecnica delle Marche, Ancona, Italy
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Naveed S, Qari H, Banday T, Altaf A, Para M. Mucinous Cystic Neoplasms of Pancreas. Gastroenterology Res 2014; 7:44-50. [PMID: 27785269 PMCID: PMC5051074 DOI: 10.14740/gr600e] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2014] [Indexed: 02/06/2023] Open
Abstract
The purpose of this study was to investigate the actual management of mucinous cystic neoplasm (MCN) of the pancreas. A systematic review was performed in December 2009 by consulting PubMed MEDLINE for publications and matching the key words “pancreatic mucinous cystic neoplasm”, “pancreatic mucinous cystic tumor”, “pancreatic mucinous cystic mass”, “pancreatic cyst” and “pancreatic cystic neoplasm” to identify English language articles describing the diagnosis and treatment of the MCN of the pancreas. In total, 16,322 references ranging from January 1969 to December 2009 were analyzed and 77 articles were identified. No articles published before 1996 were selected because MCNs were not previously considered to be a completely autonomous disease. Definition, epidemiology, anatomopathological findings, clinical presentation, preoperative evaluation, treatment and prognosis were reviewed. MCNs are pancreatic mucin-producing cysts with a distinctive ovarian-type stroma localized in the body-tail of the gland and occurring in middle-aged females. The majority of MCNs are slow growing and asymptomatic. The prevalence of invasive carcinoma varies between 6% and 55%. Preoperative diagnosis depends on a combination of clinical features, tumor markers, computed tomography (CT), magnetic resonance imaging, endoscopic ultrasound with cyst fluid analysis and positron emission tomography-CT. Surgery is indicated for all MCNs.
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Affiliation(s)
| | | | - Tanveer Banday
- Department of Medicine, Bangalore Medical College, India
| | | | - Mah Para
- Govt. Dental College, Srinagar, India
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Abstract
Magnetic resonance (MR) imaging of the pancreas is useful as both a problem-solving tool and an initial imaging examination of choice. With newer imaging sequences such as diffusion-weighted imaging, MR offers improved ability to detect and characterize lesions and identify and stage tumors and inflammation. MR cholangiopancreatography can be used to visualize the pancreatic and biliary ductal system. In this article, the use of MR to evaluate the pancreas, including recent advances, is reviewed and the normal appearance of the pancreas on different imaging sequences, as well as inflammatory diseases, congenital abnormalities, and neoplasms of the pancreas, are discussed.
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Affiliation(s)
- Erin O'Neill
- Department of Radiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Northwestern University, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611, USA
| | - Nancy Hammond
- Department of Radiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Northwestern University, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611, USA
| | - Frank H Miller
- Department of Radiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Northwestern University, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611, USA.
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Abstract
OBJECTIVES We evaluated whether pancreatic main duct fluid can provide protein biomarkers with prognostic value. METHODS Mass spectrometry proteomics was applied to as little as 20µL of fluid collected at the time of tumor surgical resection. Biomarker proteins identified for 27 patients were correlated with clinical outcomes. RESULTS Thirteen patients had pancreatic ductal adenocarcinomas, 4 had intraductal papillary mucinous neoplasm with in situ adenocarcinoma, 5 had ampullary adenocarcinomas, 2 had intraductal papillary mucinous neoplasms, and 3 had benign diseases. In pathologic stage II or higher pancreatic ductal adenocarcinoma, moderate or high expression of S100A8 or S100A9 proteins was associated with a median disease recurrence-free survival of 5.8 months compared with 17.3 months in patients with low expression (P = 0.002). Median overall survival was 12.6 versus 27 months for patients with moderate to high versus low S100A8 and A9 expression (P = 0.02). CONCLUSIONS This analysis suggests distinct proteomic signatures for pancreatic cancer. Patients in our study with elevated levels of S100A8 or A9 in the ductal fluid, a near absence of pancreatic enzymes, and high levels of mucins were found to have significantly worse prognosis. Although further validation is needed to corroborate these findings, analysis of pancreatic ductal fluid is a promising tool for identifying biomarkers of interest.
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Ohtsuka T, Takahata S, Takanami H, Ueda J, Mizumoto K, Shimizu S, Tanaka M. Laparoscopic surgery is applicable for larger mucinous cystic neoplasms of the pancreas. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 21:343-8. [DOI: 10.1002/jhbp.32] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Takao Ohtsuka
- Department of Surgery and Oncology; Graduate School of Medical Sciences; Kyushu University; 3-1-1 Maidashi, Higashi-ku Fukuoka 812-8582 Japan
| | - Shunichi Takahata
- Department of Surgery and Oncology; Graduate School of Medical Sciences; Kyushu University; 3-1-1 Maidashi, Higashi-ku Fukuoka 812-8582 Japan
| | - Hideki Takanami
- Department of Surgery and Oncology; Graduate School of Medical Sciences; Kyushu University; 3-1-1 Maidashi, Higashi-ku Fukuoka 812-8582 Japan
| | - Junji Ueda
- Department of Surgery and Oncology; Graduate School of Medical Sciences; Kyushu University; 3-1-1 Maidashi, Higashi-ku Fukuoka 812-8582 Japan
| | - Kazuhiro Mizumoto
- Department of Surgery and Oncology; Graduate School of Medical Sciences; Kyushu University; 3-1-1 Maidashi, Higashi-ku Fukuoka 812-8582 Japan
| | - Shuji Shimizu
- Department of Surgery and Oncology; Graduate School of Medical Sciences; Kyushu University; 3-1-1 Maidashi, Higashi-ku Fukuoka 812-8582 Japan
| | - Masao Tanaka
- Department of Surgery and Oncology; Graduate School of Medical Sciences; Kyushu University; 3-1-1 Maidashi, Higashi-ku Fukuoka 812-8582 Japan
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Zaheer A, Pokharel SS, Wolfgang C, Fishman EK, Horton KM. Incidentally detected cystic lesions of the pancreas on CT: review of literature and management suggestions. ACTA ACUST UNITED AC 2013; 38:331-41. [PMID: 22534872 DOI: 10.1007/s00261-012-9898-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To facilitate a better understanding of incidentally noted cystic pancreatic lesions, since these lesions often pose a challenge regarding appropriate management. METHODS This article reviews pathophysiology, prevalence, significance, and recommendations for management of the various pancreatic cystic lesions. Illustrative cases are demonstrated. RESULTS Diagnostic benign lesions can be left alone. Cross-sectional imaging can be used to follow-up benign appearing lesions and to stage more aggressive ones. Endoscopic ultrasound with fine needle aspiration and cyst fluid analysis can be performed on certain indeterminate lesions. Lesions with high malignant potential should undergo resection. CONCLUSIONS A better understanding of the variety of incidentally detected pancreatic cystic lesions can help direct appropriate management.
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Affiliation(s)
- Atif Zaheer
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 601 N. Caroline Street, JHOC 3235 A, Baltimore, MD 21231, USA.
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Atiq M, Suzuki R, Khan AS, Krishna SG, Ridgway TM, Guha S, Hernandez LV, Nealon WH, Lee JH, Bhutani MS. Clinical decision making in the management of pancreatic cystic neoplasms. Expert Rev Gastroenterol Hepatol 2013; 7:353-60. [PMID: 23639093 DOI: 10.1586/egh.13.23] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pancreatic cystic lesions continue to pose diagnostic and management dilemmas for physicians. This may be related, in part, to the fact that these lesions represent a range of diagnostic possibilities, from inflammatory cysts and nonmucinous cysts to mucinous cysts, which may or may not have foci of invasive malignancy. Adequate characterization of cystic lesions is necessary to help devise a management plan. Moreover, patient-related factors such as comorbid conditions are often essential in deciding whether patients should be managed by a conservative approach of watchful waiting versus surgical resection, if so indicated. This review summarizes the recent advances in the management of pancreatic cystic neoplasms.
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Affiliation(s)
- Muslim Atiq
- Sanford Digestive Health Center, University of South Dakota, Sioux Falls, SD, USA
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Farah JFDM, Lupinacci RM, Apodaca-Torres FR. Laparoscopic resection of pancreatic cystadenomas. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2013; 25:165-8. [PMID: 23411805 DOI: 10.1590/s0102-67202012000300006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 05/26/2012] [Indexed: 01/04/2023]
Abstract
BACKGROUND Laparoscopic pancreatic resections have become increasingly frequent with good results reported by several centers. However, few studies have focused on laparoscopic treatment of pancreatic cystic lesions. AIM To analyze the results of minimally invasive treatment of pancreatic cystic lesions. METHODS Were included all laparoscopic pancreatic resections performed at three centers. Surgical procedures included resection of the pancreas and left enucleations (with or without splenectomy). The post-operative complications were classified according to the classification proposed by Clavien and Dindo6. The diagnosis of pancreatic fistula was confirmed if the amylase dosage of the drainage liquid in the third postoperative day was more than three times the amount of serum amylase. RESULTS Were performed 44 laparoscopic pancreatic resections. Fifteen patients underwent surgery for suspected pancreatic cystadenoma and 13 had this diagnosis confirmed. There were 12 women (92%), and the average age of patients was 50 years. Six patients had minor postoperative complications. There were five (38%) pancreatic fistulas, neither considered as severe (C), and only one patient required hospital readmission and radiological drainage. In this series, there were no conversions, reoperations, or mortality. CONCLUSIONS The laparoscopic approach is a safe and effective option for the treatment of pancreatic cystic lesions. The incidence of pancreatic fistula has good evolution and not diminishes the benefits of minimally invasive surgery.
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Talar-Wojnarowska R, Pazurek M, Durko L, Degowska M, Rydzewska G, Smigielski J, Janiak A, Olakowski M, Lampe P, Grzelak P, Stefanczyk L, Malecka-Panas E. Pancreatic cyst fluid analysis for differential diagnosis between benign and malignant lesions. Oncol Lett 2012; 5:613-616. [PMID: 23420052 PMCID: PMC3573134 DOI: 10.3892/ol.2012.1071] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 10/16/2012] [Indexed: 01/07/2023] Open
Abstract
The majority of pancreatic cysts are detected incidentally when abdominal imaging is performed during unrelated procedures. The aim of the present study was to assess the diagnostic utility and clinical value of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9) and amylase analysis in pancreatic cyst fluid. The study included 52 patients with pancreatic cystic lesions, who underwent fine-needle aspiration biopsy to collect cystic fluid for cytological and biochemical analysis. Cysts were classified as benign (simple cysts, pseudocysts and serous cystadenomas) in 36 patients or premalignant/malignant (mucinous cyst-adenomas, intraductal papillary mucinous neoplasm and cystadenocarcinomas) in 16 patients. CEA and CA 19-9 were elevated in patients with malignant cysts (238±12.5 ng/ml and 222±31.5 U/ml, respectively) compared with benign lesions (34.5±3.7 ng/ml and 18.5±1.9 U/ml, respectively; P<0.001). Based on these results, the sensitivity and specificity of CEA were 91.8 and 63.9% and of CA 19-9 were 81.3 and 69.4%, respectively. Mean amylase levels in benign lesions (27825.7±91.9 U/l) were higher compared with malignant pancreatic cysts (8359.2±32.7 U/l; P<0.05). Cyst fluid analysis may prove a safe and useful adjunct for the differential diagnosis of pancreatic cystic lesions. In the present study, promising results for CEA and CA 19-9 have been demonstrated, however, the clinical value of these molecules must be confirmed.
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Gore RM, Wenzke DR, Thakrar KH, Newmark GM, Mehta UK, Berlin JW. The incidental cystic pancreas mass: a practical approach. Cancer Imaging 2012; 12:414-21. [PMID: 23022726 PMCID: PMC3460559 DOI: 10.1102/1470-7330.2012.9054] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Technical advances in cross-sectional imaging have led to the discovery of incidental cystic pancreatic lesions in the oncology and non-oncology population that in the past remained undetected. These lesions have created a diagnostic and management dilemma for both clinicians and radiologists: should these lesions be ignored, watched, aspirated, or removed? In this review, recommendations concerning the assessment of the more common pancreatic cystic incidental lesions are presented.
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Affiliation(s)
- Richard M Gore
- Department of Radiology, North Shore University Health System, University of Chicago, Pritzker School of Medicine, Evanston, IL, USA.
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Talar-Wojnarowska R, Pazurek M, Durko L, Degowska M, Rydzewska G, Smigielski J, Janiak A, Olakowski M, Lampe P, Grzelak P, Stefanczyk L, Smolarz B, Malecka-Panas E. A comparative analysis of K-ras mutation and carcinoembryonic antigen in pancreatic cyst fluid. Pancreatology 2012; 12:417-20. [PMID: 23127529 DOI: 10.1016/j.pan.2012.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 08/04/2012] [Accepted: 08/06/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND/AIMS Analysis of cystic fluid may be useful in distinguishing between benign and malignant cysts which has significant impact on their management. The aim of our study was to assess the diagnostic utility of carcinoembryonic antigen (CEA) and K-ras gene mutation in pancreatic cysts fluid. METHODS The study included 56 patients with pancreatic cystic fluid collected for analysis. The cysts were classified as benign (simple cysts, pseudocysts, serous cystadenoma) - 39 patients or premalignant/malignant (mucinous cystadenoma, IPMN, cystadenocarcinoma) - 17 patients. The patients history, CEA fluid concentrations and presence of K-ras mutation were analyzed. RESULTS CEA were higher in patients with malignant cysts (mean levels 238 ± 12.5 ng/ml; range 32.8-4985 ng/ml) compared to benign lesions (mean levels 34.5 ± 3.7 ng/ml; range 3.9-693 ng/ml; p < 0.001). K-ras mutation correctly classified 11 of 17 patients with premalignant/malignant lesions. It was also detected in 1 patient with final diagnosis of benign cyst (the sensitivity 64.7% and the specificity 97.4%; p < 0.01). If CEA and molecular analysis were combined in that cysts with either CEA level>45 ng/ml or presence of K-ras mutation, than 16 of 17 premalignant/malignant cysts were correctly identified (94.1%). CONCLUSION Molecular analysis of pancreatic cyst fluid adds diagnostic value to the preoperative diagnosis and should be considered when cyst cytologic examination is negative for malignancy.
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Grützmann R, Post S, Saeger HD, Niedergethmann M. Intraductal papillary mucinous neoplasia (IPMN) of the pancreas: its diagnosis, treatment, and prognosis. DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:788-94. [PMID: 22163260 DOI: 10.3238/arztebl.2011.0788] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 03/21/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND The many varieties of cystic pancreatic tumor, and especially intraductal papillary mucinous neoplasia (IPMN), have attracted increased attention recently. Their incidence may be rising, and their histopathological evaluation and classification have become more precise than before. METHODS We discuss the current diagnostic evaluation of IPMN, along with treatment and prognostication, on the basis of the current international guideline as well as pertinent literature retrieved by a selective PubMed search. RESULTS The preoperative diagnostic evaluation of IPMN is often problematic. In particular, it may not be possible to differentiate main-duct disease from branch-duct disease (MD-IPMN vs. BD-IPMN) before surgery--a distinction with implications for prognosis and treatment, as MD-IPMN is more often malignant. An IPMN adenoma can develop into invasive pancreatic cancer. Because firm diagnostic criteria are still lacking, it is recommended that all MD-IPMN lesions and all large BD-IPMN lesions should be resected. Partial pancreatectomy with clean margins is the treatment of choice. CONCLUSION As IPMN seems to be a slow-growing precursor of pancreatic cancer, it is possible that its early detection and surgical treatment can lead to a cure. No conclusion about the efficacy of surveillance and follow-up programs can be drawn from the available evidence. A better understanding of the natural course of IPMN and the biology of pancreatic cancer is needed to enable further improvements in diagnosis and treatment.
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Affiliation(s)
- Robert Grützmann
- Chirurgische Klinik, Universitätsmedizin Mannheim, Med. Fakultät Mannheim, Mannheim, Germany
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50
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Bang JY, Varadarajulu S, Arnoletti JP. Mucinous cystic neoplasm of the pancreas. Clin Gastroenterol Hepatol 2011; 9:e80-1. [PMID: 21596157 DOI: 10.1016/j.cgh.2011.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 04/11/2011] [Accepted: 04/13/2011] [Indexed: 02/07/2023]
Affiliation(s)
- Ji Young Bang
- Department of Internal Medicine, University of Alabama at Birmingham, USA
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