Cystic neoplasms of the exocrine pancreas

Campbell, Fiona; Azadeh, Bahram

doi:10.1111/j.1365-2559.2007.02856.x

Cited by 74 publications

(70 citation statements)

References 188 publications

(182 reference statements)

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“…The tumor is characterized by a combination of solid components consisting of pseudopapillae with fibrovascular stalks and cystic components with variable degeneration and hemorrhage [40,41,42]. Although an SPN is defined as an exocrine tumor of the pancreas, its exact origin is not known [43].…”

Section: Discussionmentioning

confidence: 99%

Clinical and Pathological Features of Solid Pseudopapillary Neoplasms of the Pancreas at a Single Institution

Suzuki¹,

Hatori²,

Furukawa

et al. 2014

Dig Surg

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Aims: The aim of this study was to determine the clinicopathological features and surgical management of solid pseudopapillary neoplasms (SPNs) of the pancreas at a single institution. Methods: We investigated 34 patients (5 males and 29 females) who underwent surgery for pathologically confirmed SPNs between 1994 and 2012. Results: Clinical symptoms were absent in 58.8% of the patients. The median tumor diameter was 42.7 mm. All tumors were successfully removed by R0 resection. Pathologically, 5.9% had duodenum invasion and 2.9% had pancreatic serosal invasion, but there was no lymph node metastasis. Radiological findings showed calcification in 39.4% of the patients, capsule formation in 51.5%, cystic components in 69.7%, solid components in 93.9% and internal bleeding in 36.4%. Immunohistochemically, neuron-specific enolase was positive in 100% of the patients, nuclear accumulation of β-catenin in 100% and CD10 in 78.8%. There were no recurrences reported at the median follow-up (67 months). Regarding gender differences, the cystic component in radiological imaging was the only significant finding among the features studied (p = 0.01). Conclusions: R0 resection with appropriate procedures appears to be sufficient for patients with SPNs, even for locally invasive tumors. There were no significant differences between genders except for the cystic component on radiological imaging.

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Section: Discussionmentioning

confidence: 99%

Clinical and Pathological Features of Solid Pseudopapillary Neoplasms of the Pancreas at a Single Institution

Suzuki¹,

Hatori²,

Furukawa

et al. 2014

Dig Surg

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“…1 MCNs occur usually in females from 3rd to 7th decade, with a peak incidence in the 5th decade (mean age 49 years). 2 Histologically, they are characterized by mucin-producing epithelial cells with an "ovarian-like" stroma, 3 probably owing to the degeneration of embryologic remnants of the left primordial ovarian gonad in the dorsal pancreatic bud. 4 Epithelial cells of MCNs delimit a cystic cavity that typically does not communicate with the ductal pancreatic system.…”

Section: Introductionmentioning

confidence: 99%

Pancreatic mucinous cystoadenomas and cystoadenocarcinomas: differential diagnosis by means of MRI

Paola

Manfredi

Mehrabi

et al. 2016

BJR

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Objective: To determine the accuracy of MRI in differentiating mucinous cystoadenomas (MCAs) from mucinous cystoadenocarcinomas (MCACs) of the pancreas, with histopathological analysis as the reference standard, for better surgical planning. Methods: A total of 65 patients with histopathologically proven mucinous cystic neoplasms (MCNs) underwent MRI and surgery. Quantitative image analysis included size, septa and wall thickness and number of loculations. Qualitative image analysis included nodules; hyperintensity of the cystic content on T 1 weighted images; compression and/or infiltration of adjacent vessels or organs; and metastases. A comparison between MCAs and MCACs was performed with Student's t-test for quantitative variables and with Fisher test for qualitative variables. Receiver operating characteristic analysis was performed to determine the accuracy in the differential diagnosis between MCAs and MCACs on the basis of a score system obtained by giving 1 point for each quantitative and qualitative variable observed in each patient.Results: At histopathology, 43 lesions were MCAs and 22 lesions were MCACs. A statistically significant difference was observed for size .7cm (,0.001), septa and wall thickness .3 mm (,0.0001), number of loculations .4 (,0.0001), nodules (,0.0001), hyperintensity of the cystic content on T 1 weighted images (,0.0001), compression (,0.01) and/or infiltration (,0.01) of adjacent vessels or organs and metastases (,0.05). The best cutoff value to discriminate MCAs from MCACs was the presence of three features ( p , 0.001), with an accuracy of 91%. Conclusion: MRI has an accuracy of 91% in the differential diagnosis between MCA and MCAC, helping in identifying forms that could undergo parenchyma-sparing surgery (MCAs), reducing post-surgical morbidity and mortality. Advances in knowledge: In this study, the differentiation between MCAs and MCACs of the pancreas by means of MRI is addressed. The differential diagnosis allows selecting benign forms, susceptible of parenchyma-sparing surgery, with the advantage of reducing post-surgical morbidity and stratifying prognosis of MCNs.

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“…MCNs may also harbour solid areas containing invasive carcinoma. 18,19 A thickened wall, calcification and vascular involvement are suggestive of malignant changes. Aspirated fluid is viscous and typically clear, but may be blood-stained or contain necrotic material.…”

Section: Mucinous Cystic Neoplasmmentioning

confidence: 99%

A review of pancreatic cyst fluid analysis in the differential diagnosis of pancreatic cyst lesions

Boot

2013

Ann Clin Biochem

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Diagnosis and management of pancreatic cyst lesions is challenging as there is currently no investigation that offers both high diagnostic sensitivity and high specificity for the identification of potentially malignant lesions. Accurate classification of these lesions is vital in order to avoid unnecessary treatment of benign lesions and missed opportunities for early treatment of lesions that are malignant/pre-malignant. Pancreatic cyst fluid analysis has an important role in diagnosis, although all currently available investigations based on fluid analysis have significant limitations. Cytological analysis can reveal features that are specific for a certain class of cyst, but offers limited sensitivity in detecting malignant/premalignant cysts. Measurement of tumour markers, particularly carcinoembryonic antigen can also be informative. Concentrations of cyst fluid carcinoembryonic antigen tend to be higher in malignant/pre-malignant cysts, although there is a wide overlap between the various classes of cyst. A number of studies have suggested that diagnostic carcinoembryonic antigen cut-offs can be chosen that provide a high degree of specificity but limited sensitivity. Studies of the analytical validity of tumour marker assays in pancreatic cyst fluid analysis have highlighted discrepancies in some fluid specimens, which require further investigation. DNA analysis also has a role. In particular, K-Ras-2 mutational analysis appears to provide high specificity for detection of malignant/pre-malignant lesions. A number of diagnostic algorithms have been published, integrating use of available investigations in order to achieve the optimum discrimination of benign and potentially malignant cysts. Research into new biochemical markers and optimal use of available pancreatic cyst fluid analyses is ongoing.

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Cystic neoplasms of the exocrine pancreas

Cited by 74 publications

References 188 publications

Clinical and Pathological Features of Solid Pseudopapillary Neoplasms of the Pancreas at a Single Institution

Clinical and Pathological Features of Solid Pseudopapillary Neoplasms of the Pancreas at a Single Institution

Pancreatic mucinous cystoadenomas and cystoadenocarcinomas: differential diagnosis by means of MRI

A review of pancreatic cyst fluid analysis in the differential diagnosis of pancreatic cyst lesions

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