Demographic and clinical features age of presentation. Preoperative risk factors and pancreatic mucinous cystic. The study by postlewait and coworkers 1 presents the largest series of surgically treated mucinous cystic neoplasms mcns of the pancreas to date. Diagnosis and management of pancreatic cystic neoplasms. Ipmt were most frequently found in men and in the head of the pancreas. Mucinous cystic neoplasms of the liver are a type of liver cancer in which tissue similar to the stroma of ovary occurs.
Mucinous cystic neoplasms 2030% of cystic neoplasms of the pancreas more common in females than males, with over 90% of patients being female. Pancreatic cysts are usually found when patients undergo. Most of these lesions are benign or slow growing and. Diagnosis and management of cystic lesions of the pancreas. Invasive ductal carcinoma arising in mucinous cystic neoplasm. Eus is equivalent to magnetic resonance imaging mri in detecting mpd communication in pancreatic cysts. Cystic neoplasms are an uncommon group among pancreatic tumors. Primordial germ cells as a potential shared cell of origin. Primordial germ cells as a potential shared cell of origin for mucinous cystic neoplasms of the pancreas and mucinous ovarian tumors kevin m elias division of gynecologic oncology, department of obstetrics and gynecology and reproductive biology, brigham and. Pancreatic cystic neoplasms risk of cancer subtype risk of malignancy main duct mdipmn 3668% mixed mixedipmn 3865% branch bdipmn 1247% mucinous cystic neoplasm mcn 1017% solid pseudopapillary neoplasm spn 820% cystic pancreatic neuroendocrine tumor cpnet 631%. However, only the cystic and cavernous types have been reported in the pancreas, and sometimes, the tumor has a mixture of these 2 histological characteristics. Cystic neoplasm of the pancreas europe pmc article. There are numerous primary pancreatic neoplasms, in part due to the mixed endocrine and exocrine components classification classification based on function. European evidencebased guidelines on pancreatic cystic neoplasms the european study group on cystic tumours of the pancreas abstract evidencebased guidelines on the management of pancreatic cystic neoplasms pcn are lacking.
Cystic neoplasms of the pancreas cnps are not considered as rare entities any more. Pancreatic cysts and neoplasms nicole kershner, md. It typically affects young noncaucasian females in their second or third decade of life. Cystic lesions arising from ipmn were considered mucinous. Imagingbased population studies attested an overall prevalence of 2 %, but that becomes five times higher on individuals of more than 70 year old.
The world health organization who further classified mucinproducing cystic tumors of the pancreas into 2 distinct entities. The median age of presentation is reported to be 48 range 1682 and tumors are preferentially located in the body. Pancreatic cystic tumors comprise a variety of neoplasms with a wide range of malignant potential. Pancreatic cysts are challenging lesions to diagnose and to treat. Cystic neoplasms of the pancreas are rare tumors with a relatively better prognosis as compared to other pancreatic cancers. Mucinous cystic neoplasm benign, borderline, malignant 2. These lesions are seen frequently in recent surgical practice, probably because of ad vances in diagnostic and surgical techniques. Among these, 28 patients were found to have a cystic lesion in the bodytail of. Cystic neoplasms of pancreas cnp are frequently diagnosed with improved radiological imaging. These lesions are benign, though there is a high rate of progression to cancer. Clinical characteristics of the 41 patients with mucinous cystic neoplasm or serous cystic neoplasm as shown in, a total of 41 patients were pathologically proven to have mcn or scn in the pancreas 6 males, 35 females. European evidencebased guidelines on pancreatic cystic. Mucinous cystic neoplasm mcn is the second most frequent cystic neoplasm of the pancreas, representing 23 % of all resected pancreatic cysts. Solid pseudopapillary neoplasm of the pancreas is one of the rarest forms of pancreatic neoplasm.
There are numerous primary pancreatic neoplasms, in part due to the mixed endocrine and exocrine components. Cystic neoplasm of the pancreas europe pmc article europe pmc. Feb, 2016 mucinous cystic neoplasms 2030% of cystic neoplasms of the pancreas more common in females than males, with over 90% of patients being female. This guideline is a joint initiative of the european study group on cystic tumours of the pancreas, united european gastroenterology, european pancreatic club, europeanafrican hepatopancreatobiliary association, european digestive surgery, and the european society of gastrointestinal endoscopy. Incidental pancreatic cysts are increasingly recognized due to the widespread use of crosssectional imaging techniques such as ct and mri. Pancreatic cystic neoplasms, mucinous cystic neoplasm, molecular analysis, endoscopic ultrasound. Identifying premalignant cysts offers the opportunity to prevent the development of pancreatic cancer. Intraductal papillary mucinous neoplasm of the pancreas.
Cystic neoplasms of the pancreas healthcare baylor. Pancreatic mucinous cystic neoplasm mcn is a type of cystic lesion that occurs in the pancreas. A 28yearold japanese woman was admitted to the emergency department of a local hospital after experiencing. Cystic neoplasms of the pancreas are relatively uncommon and account for only 1% of pancreatic neoplasms 51. Cystic neoplasms of the pancreas may be more frequent than previously recognized and are being identified with increasing frequency as the use of abdominal ct scanning has increased. Intraductal papillary mucinous neoplasm ipmn is an increasingly recognized mucin. Cystic lesions of the pancreas linkedin slideshare. A number of lesions in the pancreas can form cysts, including serous cystadenomas sca, mucinous cystic neoplasms mcns, intraductal papillary mucinous neoplasms ipmns, solidpseudopapillary neoplasms spns, and pseudocysts. This guideline is a joint initiative of the european study group on cystic tumours of the pancreas, united. Points of differentiation between these neoplasms, the use of cyst fluid analysis and an approach to the incidentally discovered cystic mass will be addressed. Management of pancreatic cystic lesions fulltext digestive. This is important because a precise diagnosis determines the treatment and surgical approach. Cystic neoplasms of the pancreas range from completely benign to frankly malignant.
It was also known as franzs tumor or hamoudi tumor until the world health organization who labeled it as a solid pseudopapillary tumor in 1996. Management decisions, including imaging followup or surgical resection, may be based on the presence of symptoms, patient age, tumor size, and location. A case of ruptured mucinous cystadenoma of the pancreas. Oct 28, 2015 cystic neoplasms of the pancreas cnps are not considered as rare entities any more. Treatment involves complete excision of the tumor which. Cystic neoplasm of the pancreas pubmed central pmc.
Pancreatic cancer cystic neoplasms and endocrine tumors pdf diagnosis and management 2015 pancreatic cancer cystic neoplasms and endocrine tumors pdf free download pancreatic cancer cystic neoplasms and endocrine tumors pdf pancreatic cancer cystic neoplasms and endocrine tumors ebook content now into the second decade of the 21st century, the body of data about. Mucinous cystic neoplasms of the pancreas are defined by the world health organization who as cystic epithelial neoplasms that occur almost exclusively in women. A case of ruptured mucinous cystadenoma of the pancreas with. Org september 16, 2004 cystcyst c eop as s ic neoplasms pancreatic neoplasms benign, malignant, and borderline neoplasms that either are primarily cystic. In contrast with solid tumors, most of which are invasive ductal adenocarcinoma with dismal prognosis, cystic lesions of the pancreas are often either benign or lowgrade indolent neoplasia. Ppt diagnosis of pancreatic cystic neoplasms powerpoint. In a study of 1064 pancreatic cystic neoplasm pcn patients pathologically confirmed over a 12. The median age of presentation is reported to be 48 range 1682 and tumors are preferentially located in.
While the risk for undergoing malignant transformation is dependent on a number of factors, the risk is certainly present, differentiating it from other cystic lesions of the pancreas. A cystic neoplasm needs to be considered when a patient presents with a fluidcontaining pancreatic lesion. Although cystic tumors of the pancreas are relatively rare, they constitute an increasingly important category. Eight academic centers in the united states have contributed to this cohort, and the authors show an overall malignancy rate of 15% mostly associated with male sex, pancreatic head and neck location, increased size, mural nodules, and duct. Mucinous cystadenomas and intraductal mucinous papillary neoplasms have malignancy potential. Pdf pancreatic cancer cystic neoplasms and endocrine tumors.
Compagno and oertel proposed to separate cystic, mucinproducing pancreatic neoplasm from serous cystic neoplasm of the pancreas in 1978. Pancreatic cystic lesions pcls with malignant potential include. Al though cystic neoplasms of the pancreas had tradi tionally been classified into two categories, i. Cystic lesions of the pancreas are a diverse group of lesions, ranging from benign processes to invasive malignant tumors, and often can be morphologically differentiated on ct and mri on the basis of characteristic features. Intraductal papillary mucinous neoplasm ipmn is a benign cystic lesion that grows in the pancreatic ductal system. Endoscopic diagnosis of cystic lesions of the pancreas. New criteria to differentiate between mucinous cystic. After pseudocyst and cystic degeneration of a pancreatic adenocarcinoma are excluded, the management of a pancreatic cystic neoplasm can be quite variable. Management of pancreatic cystic lesions intechopen. Imagebased studies report prevalences of pancreatic cystic lesions ranging from 1. Clinicopathologic features and postoperative longterm outcomes were investigated. Diseasefree survival was defined as the length of time the patient lives. Oct 28, 2015 mucinous cystic neoplasm mcn is the second most frequent cystic neoplasm of the pancreas, representing 23 % of all resected pancreatic cysts. They are equally common in women and men with peak presentation in the 60 s.
Mucinous cystic neoplasms mcns of the pancreas are rare cysts with malignant potential that typically occur in the pancreatic body or tail of perimenopausal women. Lymphangiomas are benign cystic tumors, commonly occur in the neck, axilla, and mediastinum. Cystic pancreatic neoplasms are uncommon, but are being seen more frequently due to the widespread use of crosssectional imaging. Some authors have recommended resection for all cystic neoplasms of the pancreas,14,15,19 whereas others including our group advocate a more selective approach. Pancreatic cancer cystic neoplasms and endocrine tumors. Additionally, impn is to be starkly contrasted with adenocarcinoma of the pancreas, which is. References this article about a neoplasm is a stub. Pancreatic cystic neoplasms serous cystadenomas scas, mucinous cystic neoplasms mcns, intraductal papillary mucinous neoplasms ipmns, solid pseudopapillary neoplasms spns pancreatic adenocarcinoma pancreatic endocrine neoplasms. Evidencebased guidelines on the management of pancreatic cystic neoplasms pcn are lacking. Diagnosis and management is a modern, expertly crafted and clinically focused guide to the diagnosis, management and bestpractice care of patients suffering from pancreatic cancer, cystic neoplasms and endocrine tumours. Org september 16, 2004 cystcyst c eop as s ic neoplasms cystic neoplasms and endocrine tumors. Tumor markers cea, ca 724, ca 125, ca 199, and ca 153.
Pancreatic cysts and neoplasms university of louisville. Owing to improvements in imaging techniques, cystic lesions of the pancreas are being identified more often, even in patients who are asymptomatic. Eight academic centers in the united states have contributed to this cohort, and the authors show an overall malignancy rate of 15% mostly associated with male sex, pancreatic head and neck location, increased size, mural nodules, and duct dilation. Later, in 2000, the world health organization who proposed criteria that further defined mcns by. Pancreatic cystic lesionssurgical managementintraductal papillary mucinous. Separate roc curves were plotted for each tumor marker and. The latter lesion affects mainly postmenopausal women, whereas the other cystic neoplasms occur in fertile women. Pancreatic cystic neoplasms are fluidfilled sacs cysts within the pancreas. Diagnosis and treatment of pancreatic cystic neoplasms. Mucinous cystadenomas, mucinous cystadenocarcinomas, pcns, and serous cystadenomas occur more commonly in females see table 432. Cystic pancreatic neoplasms cancer imaging full text. Mcns occur almost exclusively in female, such as male cases are reported to be extremely rare 910.
Three histological subtypes of the disease are predominant. Seventeen patients who underwent surgical resection were analyzed. Pancreatic neoplasms definition of pancreatic neoplasms by. We report a case of ruptured mca of the pancreas with recurrence free survival for 8 years. Pancreatic mucinous cystic neoplasm mcm presenting with rupture is extremely rare, and very few studies have followed up patients over the long term after ruptured mucinous cystadenoma mca. Advances in imaging and interventional techniques and the sharp drop in the. Pancreatic cancer, cystic neoplasms and endocrine tumors. Separate roc curves were plotted for each tumor marker and the auc was used to quantify predictive power.
The safety and efficacy of an alcoholfree pancreatic cyst ablation. European evidencebased guidelines on pancreatic cystic neoplasms. The japan pancreas society performed a multiinstitutional, retrospective study of 79 cases of intraductal papillary mucinous tumor ipmt and 179 cases of mucinous cystic tumor mct of the pancreas. They may occur sporadically or in individuals with multiple endocrine neoplasia type 1. Pancreatic cystic neoplasms pcn are estimated to be present in. Cystic neoplasms of the pancreas johns hopkins university. Amongst individuals undergoing surgical resection of a pancreatic cyst, about 23 percent were mucinous cystic neoplasms. Prognostic indicators of malignant ipmt included advanced age, positive symptoms, abundant mucous secretion, presence of large nodules andor large cysts, remarkable dilatation of the main pancreatic duct, and main. Pancreatic neuroendocrine tumors are rare and usually nonfunctioning. Differential diagnosis of pancreatic cystic lesions.
Cystic tumors of the pancreas diagnosis and treatment marco. Cystic neoplasms of the pancreas michigan state university. Classification of cystic neoplasms and lesions of pancreas 3. Those that are mucinous, namely, intraductal papillary mucinous neoplasms ipmns and mucinous cystic neoplasms mcns, constitute the most important category, not only because they are the most. Early detection of pancreatic cystic neoplasms full text. Account for 12% of all pancreatic tumors and are classified according to their histologic origin 7.
Seventy percent of the patients were females and 76. Serous cystic neoplasms constitute the most common type of true cystic neoplasm of the pancreas. In this article, we will address the clinical and imaging features of the more commonly seen neoplasms. Diagnosis and management is a modern, expertly crafted and clinically focused guide to the diagnosis, management. Mcns are solitary lesions, occurring almost universally in the body or tail of pancreas 97% of females 98% in their fifth and sixth decade of life. Epidemiologic and biologic characteristics of pancreatic cystic neoplasms.
1254 1422 1344 256 255 597 1047 739 1216 432 1315 1212 109 199 264 740 747 783 741 1273 386 1252 983 1418 708 369 1259 658 887 1348 1426 139 1084 1499 776 666 1286 731 112 1249 476 497 948 897 123 1400 630 1218 471 624