Cystic Neoplasms of the Exocrine Pancreas An Update of a Nationwide Survey in Korea
ABSTRACT The purpose of this study was to update a previous study of cystic neoplasms of the pancreas (PCNs) conducted in Korea by the authors.
Clinicopathologic data and factors associated with malignancy were evaluated from PCNs originating from the exocrine pancreas diagnosed between January 1993 and June 2005 in 30 university hospitals throughout Korea.
A total of 1064 pathologically confirmed PCNs, which consisted of the following diagnoses, were collected: intraductal papillary mucinous neoplasm (IPMN), 436; mucinous cystic neoplasm (MCN), 268; solid pseudopapillary neoplasm (SPN), 195; serous cystic neoplasm (SCN), 162; acinar cell cystic neoplasm 2; and mature teratoma, 1. No malignant SCNs were diagnosed. In IPMN, advanced age, pancreatic head involvement, and hyperbilirubinemia were associated with malignancy based on multivariate analysis. In MCN, pancreatic head involvement was associated with malignancy based on multivariate analysis.
Intraductal papillary mucinous neoplasms were the most common PCN observed in Korea. Solid pseudopapillary neoplasms were observed more frequently than those in studies from western countries. In IPMNs, advanced age was associated with malignancy, suggesting an adenoma-carcinoma sequence. Involvement of the pancreatic head was associated with malignancy in both IPMNs and MCNs, possibly warranting prompt surgical interventions.
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ABSTRACT: As cystic neoplasms of the pancreas are discovered with advanced imaging techniques, pancreatic surgeons often struggle with identifying who is at risk of having or developing pancreatic cancer. We sought to review our experience with the surgical management of cystic neoplasms of the pancreas to determine pre-operative clinical indicators of malignancy or premalignant (i.e. mucinous) lesions. Between 1996 and 2007, 114 consecutive patients with cystic neoplasms of the pancreas underwent a pancreatectomy. Invasive adenocarcinoma was identified in 35 whereas 79 had benign lesions. Mucinous lesions were considered premalignant and consisted of 29 intraductal papillary mucinous neoplasms (IPMN) and 17 mucinous cystic neoplasms (MCN). The remaining 33 benign lesions were serous microcystic adenomas. Descriptive statistics were calculated and multivariate logistic regression was performed. Receiver-operating characteristic (ROC) curves were constructed for continuous variables and the area under the curves compared. Likelihood ratios were calculated from the combinations of predictors. Patients with pancreatic cancer arising from a cystic neoplasm were older than those with benign cysts. Mucinous lesions with or without associated cancer were more likely to be symptomatic and present with elevated serum carbohydrate antigen (CA)19-9 levels. Cancers more commonly presented in the head of the pancreas and were associated with longer hospitalizations after resection. Using multivariate logistic regression, size and elevated CA19-9 were predictors of malignancy whereas male gender and size were predictors of mucinous lesions with or without malignancy. Size, however, was not an accurate test to determine premalignant or malignant lesions using area under the ROC curve analysis whereas CA19-9 performed the best regardless of gender or lesion location. Based upon our single institution experience with resection of cystic neoplasms of the pancreas, we advocate an aggressive surgical approach to any patient with a cystic neoplasm of the pancreas and associated elevated CA19-9.HPB 12/2009; 11(8):664-70. DOI:10.1111/j.1477-2574.2009.00114.x · 2.05 Impact Factor
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ABSTRACT: Cystic lesions of the pancreas are being incidentally recognized with increasing frequency and become a common finding in clinical practice. Despite of recent remarkable advances of radiological and endoscopic assessment and a better understanding of natural history of certain subgroups of cystic lesions, differentiating among lesions and making an optimal management plan is still challenging. A multimodal approach should be performed to evaluate incidentally detected cystic lesions. Emerging evidence supports selective nonoperative management for the majority of patients with cystic lesions, but, for those in whom a suspicion of malignancy remains, surgery is indicated. Concerning long-term follow-up, there is limited data to support the ideal modality, intensity, and duration. Therefore, evidence-based guidelines for the diagnosis, management, and follow-up of cystic lesions of the pancreas should be established.The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi 03/2010; 55(3):154-61. DOI:10.4166/kjg.2010.55.3.154
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ABSTRACT: Intraductal papillary mucinous neoplasm (IPMN) was first recognized in the 1980s with increasing publications over the last decade as the incidence increased sharply, especially at tertiary-care referral centers. Population-based studies have estimated the age and sex-adjusted cumulative incidence of IPMN to be 2.04 per 100 000 person-years (95% confidence interval: 1.28-2.80). It is now understood that IPMN can be classified anywhere along the spectrum of the adenoma to carcinoma sequence and often harbors mutations in genes such as KRAS early in the disease process. Many patients are diagnosed incidentally after imaging of the abdomen for other diagnostic purposes. Patients that present with a history of symptoms such as pancreatitis and abdominal pain are at high risk of harboring a malignancy. Clinicopathologic features such as involvement of the main pancreatic duct, presence of mural nodules, and side branch disease > 3.0 cm in size may indicate that there is an underlying invasive component to the IPMN. In addition, the incidence of extra-pancreatic neoplasms is higher in patients with IPMN, with reported rates of 25% to 50%. There are no current screening recommendations to detect and diagnose IPMN but once the diagnosis is made, screening for extrapancreatic neoplasms such as colon polyps and colorectal cancer should be considered. Surgical resection is the recommend treatment for patients with high-risk features while close observation can be offered to patients without worrisome signs and symptoms of carcinoma.10/2010; 2(10):314-8. DOI:10.4240/wjgs.v2.i10.314