Pancreatic cystic neoplasms: Predictors of malignant behavior and management

Abstract

Background/Aim:Pancreatic cystic neoplasms are being increasingly identified with the widespread use of advanced imaging techniques. In the absence of a good radiologic or pathologic test to preoperatively determine the dianosis, clinical characteristics might be helpful. The objectives of this analysis were to define the incidence and predictors of malignancy in pancreatic cysts.Patients and Methods:Patients with true pancreatic cysts who were treated at our institution were included. Patients with documented pseudocysts were excluded. Demographic data, clinical manifestations, radiological, surgical, and pathological records of those patients were reviewed.Results:Eighty-one patients had true pancreatic cyst. The mean age was 47 ± 15.5 years. There were 28.4% serous cystadenoma, 21% mucinous cystadenoma, 6.2% intraductal papillary tumors, 8.6% solid pseudopapillary tumors, 1.2% neuroendocrinal tumor, 3.7% ductal adenocarcinoma, and 30.9% mucinous cystadenocarcinoma. Malignancy was significantly associated with men (P = 0.04), older age (0.0001), cysts larger than 3 cm in diameter (P = 0.001), presence of solid component (P = 0.0001), and cyst wall thickening (P = 0.0001). The majority of patients with malignancy were symptomatic (26/28, 92.9%). The symptoms that correlated with malignancy included abdominal pain (P = 0.04) and weight loss (P = 0.0001). Surgical procedures were based on the location and extension of the lesion.Conclusion:The most common pancreatic cysts were serous and mucinous cysts. These tumors were more common in females. Old age, male gender, large tumor, presence of solid component, wall thickness, and presence of symptoms may predict malignancy in the cyst.

Mucinous Cystic Neoplasms of Pancreas

“…Patients having invasive carcinoma were older, possibly suggesting progression from adenoma to carcinoma. One study demonstrated that preoperative clinical characteristic such as patients’ age, male gender, tumor size and presence of symptoms can predict malignancy in the cyst and CT scan is not sufficiently accurate to differentiate among the benign and malignant pancreatic cystic lesions [ 29 ].…”

A new combined criterion to better predict malignant lesions in patients with pancreatic cystic neoplasms

“…In our results, sex could not be considered a predictor of malignant PCN. Patients with benign MCN have a median age of 50 years, whereas patients with mucinous cyst adenocarcinoma have a median age of 65 years 3 . Other studies reported that patients with malignant cysts were older than patients with benign cysts, with statistical significance 16 , 37 .…”

“…The detection rate of pancreatic cysts has increased dramatically owing to the universal use of cross-sectional imaging modalities 1 , 2 . Pancreatic cystic neoplasms (PCNs) account for approximately 10%–15% of all pancreatic cystic lesions 1 , 3 and approximately 1% of all pancreatic neoplasms 3 . PCNs include three distinct common tumor types: serous cystic neoplasm (SCN), intraductal papillary mucinous neoplasm (IPMN), and mucinous cystic neoplasm (MCN) 4 , 5 .…”

Combined method for differential diagnosis of pancreatic cystic neoplasm

“…Некоторые исследователи предположили, что ЭУС с тонкоигольной аспирацией и анализом жидкости, полученной из кисты, обещает выявление злокачественных образований с высокой точностью [2]. Однако ЭУС не всегда доступна, методика является инвазивной и зачастую требует общего обезболивания, а цитологическое исследование полученной жидкости обладает низкой чувствительностью [21].…”

“…Частота обнаружения кист поджелудочной железы в последнее время резко возросла в результате широкого внедрения в практику новых методов диагностики с высокой разрешающей способностью, вследствие чего отмечается рост числа пациентов с небольшими бессимптомными кистами, дальнейшая тактика в отношении которых зачастую становится весьма сложной клинической проблемой [1]. Кистозные неоплазии поджелудочной железы (КНПЖ) составляют приблизительно 10-15 % всех кистозных панкреатических образований и приблизительно 1 % от всех новообразований поджелудочной железы [2]. Наиболее частыми формами КНПЖ являются: серозные цистаденомы (SCA), внутрипротоковые папиллярно-муцинозные неоплазии (IPMN) и муцинозные цистаденомы (MCA) [3], встречаются также смешанные кистозные образования [4].…”