Mucinous Cystic Neoplasms of Pancreas

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.

Preoperative differentiation of pancreatic mucinous cystic neoplasm from macrocystic serous cystic adenoma using radiomics: Preliminary findings and comparison with radiological model

“…Only patients with MaSCA were analyzed. Lesion located in the pancreatic body or tail, oval shape, thick wall, and presence of wall enhancement were independently correlated with MCN, while location in the pancreatic head, lobulated shape, and absence of wall enhancement were independently specific for MaSCA, which was consistent with previous study [8,9,30]. MaSCA typically appears as a small uni-or bilocular cyst [9] which makes it hard to differentiate from MCN.…”

“…thick fibrotic wall, with a distinctive ovarian-type stroma [30]. MaSCA is composed of epithelial cells that produce serous fluid and show evidence of ductal differentiation [9].…”

Radiological Workup of Cystic Neoplasms of the Pancreas

“…The ovarian stromal elements differentiate MCNs from IPMNs, which have stromal elements of pancreatic ductal origin. They usually present as solitary, unilocular, well-circumscribed round or lobular cysts (about 80%) that can range from small to large dimensions (1-36 cm), mostly in the pancreatic body and tail (up to 75%) [33,34]. Internal septa may be seen which can create a multilocular appearance.…”

“…Peripheral curvilinear or eggshell calcifications may be seen in the wall or internal septa in up to 25% of cases and are better depicted on CT [2,26,30]. MCNs may grow slowly over time, at an average rate of 4 mm per year [33,34]. …”

Mucinous cystadenoma of the pancreas associated with pregnancy. Case report and review of the literature

“…We describe one of these cystic pancreatic lesions, with uncommon onset, resolved through a particularly surgical intervention that conserved both exocrine and endocrine pancreatic functions. We also provide a review of the literature for presenting the state of knowledge on this type of tumors (2)(3)(4).…”