Cystic neoplasms of the pancreas - cystadenomas and cystadenocarcinomas

Meyer, W.; Köhler, Jens; Gebhardt, C

doi:10.1007/s004230050172

Cited by 21 publications

(16 citation statements)

References 15 publications

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“…This observation concurs with that of another report [11]. Mean age at presentation of those with a benign mucinous cystic neoplasm is 50 to 55 years, and that of those with a mucinous cystadenocarcinoma is 60 to 65 years [7,12,14,20,29]. Patients with benign IPMNs have a mean age of 60 to 65 years, whereas malignant IPMNs are usually found at a mean age of 65 to 70 years [23,24].…”

Section: Discussionsupporting

confidence: 91%

“…Because of the potential risks of premaligancy or malignancy associated with pancreatic cysts, surgical resection has been advocated by some authors [3,5,6]. The justification for an aggressive approach is based on the inability to differentiate benign and malignant cysts, insufficient data on natural history, relatively high incidence of premalignant or malignant cysts, and low morbidity and mortality rate after pancreatic surgery [3,[5][6][7][8][9][10]. However, data collected after surgical resection do not reflect the characteristics of cystic neoplasms incidentally found in the clinical setting.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of Cystic Lesions in the Pancreas After Extended Follow-up

et al. 2007

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Incidental pancreatic cysts are frequently detected, but no appropriate management guidelines have been issued for their management because their natural history is relatively unknown. The aim of this study was to investigate their long-term clinical outcomes. Pancreatic cysts detected from 1998 to 2004 were retrospectively reviewed in patients followed up for more than 3 months. A total of 182 patients with incidental pancreatic cysts (initial mean size, 1.8+/-1.1 cm) underwent follow-up for an average of 35.4 months. An age>/=60 years was found to be associated with an increase in cyst size, with an odds ratio of 2.56. Two malignant cysts were found among 20 patients who underwent surgical resection during follow-up. Old age was also associated with the presence of a premalignant or malignant cyst (P<0.01). Although the majority of incidental pancreatic cysts show an indolent behavior, long-term, regular follow-up studies should be considered for all pancreatic cysts, especially in the elderly.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Outcomes of Cystic Lesions in the Pancreas After Extended Follow-up

et al. 2007

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“…Prevalence of cystic neoplasms in female patients has been observed in other studies as well. 3,4,5,11,19 The overall incidence of malignancy was significantly higher in men, 14 (28%) of 67, compared to women 12(12%) of 99 (p<0.02). When analyzing individual tumor types, the overall trend of higher malignant tumors in the male population was observed; 35% of men with MCN having malignant tumors vs 23% women, and 31% of men with IPMN having invasive disease vs 14% of women.…”

Section: Discussionmentioning

confidence: 74%

“…Depending on the type of tumor, the prevalence of carcinoma associated with mucin-producing cystic neoplasms is widely varied among surgical resection series in the literature ranging from 6% to as high as 60%. [1][2][3][4][5][6][7][8][9][10][11] Although smaller tumor size is associated with a lower risk of malignancy with the lesion, upon review of literature, the natural history of mucinous lesions over time is not well characterized. Because of the uncertainty of malignant risk in the incidentally discovered cystic neoplasm, the patient presenting with a small (≤3 cm) asymptomatic tumor represents both a challenging diagnostic and management dilemma.…”

Section: Introductionmentioning

confidence: 99%

Risk of Malignancy in Resected Cystic Tumors of the Pancreas ≤3 cm in Size: Is it Safe to Observe Asymptomatic Patients? A Multi-institutional Report

Lee

Scheiman

Anderson

et al. 2008

Journal of Gastrointestinal Surgery

175

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Recent international consensus guidelines propose that cystic pancreatic tumors less than 3 cm in size in asymptomatic patients with no radiographic features concerning for malignancy are safe to observe; however, there is little published data to support this recommendation. The purpose of this study was to determine the prevalence of malignancy in this group of patients using pancreatic resection databases from five high-volume pancreatic centers to assess the appropriateness of these guidelines. All pancreatic resections performed for cystic neoplasms < or =3 cm in size were evaluated over the time period of 1998-2006. One hundred sixty-six cases were identified, and the clinical, radiographic, and pathological data were reviewed. The correlation with age, gender, and symptoms (abdominal pain, nausea and vomiting, jaundice, presence of pancreatitis, unexplained weight loss, and anorexia), radiographic features suggestive of malignancy by either computed tomography, magnetic resonance imaging, or endoscopic ultrasound (presence of solid component, lymphadenopathy, or dilated main pancreatic duct or common bile duct), and the presence of malignancy was assessed using univariate and multivariate analysis. Among the 166 pancreatic resections for cystic pancreatic tumors < or =3 cm, 135 cases were benign [38 serous cystadenomas, 35 mucinous cystic neoplasms, 60 intraductal papillary mucinous neoplasms (IPMN), 1 cystic papillary tumor, and 1 cystic islet cell tumor], whereas 31 cases were malignant (14 mucinous cystic adenocarcinomas and 13 invasive carcinomas and 4 in situ carcinomas arising in the setting of IPMN). A greater incidence of cystic neoplasms was seen in female patients (99/166, 60%). Gender was a predictor of malignant pathology, with male patients having a higher incidence of malignancy (19/67, 28%) compared to female patients (12/99, 12%; p < 0.02). Older age was associated with malignancy (mean age 67 years in patients with malignant disease vs 62 years in patients with benign lesions (p < 0.05). A majority of the patients with malignancy were symptomatic (28/31, 90%). Symptoms that correlated with malignancy included jaundice (p < 0.001), weight loss (p < 0.003), and anorexia (p < 0.05). Radiographic features that correlated with malignancy were presence of a solid component (p < 0.0001), main pancreatic duct dilation (p = 0.002), common bile duct dilation (p < 0.001), and lymphadenopathy (p < 0.002). Twenty-seven of 31(87%) patients with malignant lesions had at least one radiographic feature concerning for malignancy. Forty-five patients (27%) were identified as having asymptomatic cystic neoplasms. All but three (6.6%) of the patients in this group had benign disease. Of the patients that had no symptoms and no radiographic features, 1 out of 30 (3.3%) had malignancy (carcinoma in situ arising in a side branch IPMN). Malignancy in cystic neoplasms < or =3 cm in size was associated with older age, male gender, presence of symptoms (jaundice, weight loss, and anorexia), and presence of concerning...

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“…4,5,[12][13][14][15][16][17] These tumors are mainly located in the distal part of the pancreas, and most of them are nonmalignant and nonfunctional.…”

Section: Discussionmentioning

confidence: 99%

Cystic pancreatic neuroendocrine neoplasms with uncertain malignant potential: Report of two cases

et al. 2009

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Neuroendocrine tumors of the pancreas (NETP) represent only 1%-2% of all pancreatic neoplasms. They can be classified as functioning or non-functioning, respectively, according to the presence or absence of paraneoplastic syndrome. Case 1 concerned a 70-year-old woman with a cystic lesion of the pancreatic head and body. All tumor markers were negative. The patient underwent a distal pancreatectomy. The histology revealed a well-differentiated endocrine tumor with uncertain malignant potential. Case 2 was a 61-year-old man with chronic polyserositis. The serum tumor markers were negative, while he was strongly positive for intracystic tumor markers carcinoembryonic antigen, carbohydrate antigen (CA) 19-9, and CA 125. The patient underwent a cephalo-pancreatic duodenectomy. The preoperative differential diagnosis of cystic NETP is still a challenge due to the high rate of the nonfunctional variant. Although cystic NETPs are well differentiated, they are still tumors with a malignant potential, and therefore an early diagnosis and radical surgical resection could be associated with a better long-term survival.

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Cystic neoplasms of the pancreas - cystadenomas and cystadenocarcinomas

Cited by 21 publications

References 15 publications

Outcomes of Cystic Lesions in the Pancreas After Extended Follow-up

Outcomes of Cystic Lesions in the Pancreas After Extended Follow-up

Risk of Malignancy in Resected Cystic Tumors of the Pancreas ≤3 cm in Size: Is it Safe to Observe Asymptomatic Patients? A Multi-institutional Report

Cystic pancreatic neuroendocrine neoplasms with uncertain malignant potential: Report of two cases

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