Cystic Neoplasms of the Exocrine Pancreas An Update of a Nationwide Survey in Korea

Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Pancreas (Impact Factor: 2.96). 11/2008; 37(3):254-8. DOI: 10.1097/MPA.0b013e3181676ba4
Source: PubMed

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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    • "The World Health Organisation (WHO) classifies cystic neoplasms of the pancreas into 3 main categories: benign, premalignant, and malignant.[8] The major histologic subtypes include (a) serous cystic neoplasms (SCN), (b) mucinous cystic neoplasms (MCN), (c) IPMN), and (d) SPPN).[891011] Rarer types include cystic pancreatic endocrine neoplasms (PEN), cystic ductal adenocarcinomas, and acinar cell cystadenomas. "
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    ABSTRACT: Background:Cystic neoplasms of the pancreas are rare and constitute approximately 0.5% of all pancreatic neoplasms.Aims:The study was to describe clinicopathological features of pancreatic cystic tumors.Patients and Methods:In our retrospective study, we reviewed 10 cases of pancreatic cystic neoplasms that were diagnosed at the pathology department of Mongi Slim hospital over a 14-year period (2000-2013). We adopted the latest World Health Organization (WHO) classification (2010) in grouping all tumors.Results:There were one male and nine female patients (sex ratio M/F = 1:9) aged between 21 and 68 years (mean = 37.5 years). The most common clinical presentation was epigastric and abdominal pain (n = 6) followed by vomiting (n = 3). Abdominal computed tomography (CT) scan disclosed a cystic lesion of the pancreas ranging in size between 2 and 10 cm (mean = 6.75 cm). All patients underwent surgical treatment. Histopathological examination of the surgical specimen established the diagnosis of solid pseudopapillary neoplasm (n = 2), serous cystic neoplasm (n = 2), mucinous cystadenoma (n = 4), mucinous cystadenocarcinoma (n = 1), and intraductal papillary mucinous neoplasm with invasive carcinoma (n = 1).Conclusion:Better understanding of pancreatic cystic neoplasms is essential for clinicians to make accurate diagnosis and to provide the best management for patients.
    North American Journal of Medical Sciences 08/2014; 6(8):413-7. DOI:10.4103/1947-2714.139298
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    • "There also has been a higher incidence in the number of SPNs reported in another case series in China (17.3%) in 2005 [23]. Furthermore, a multi-institutional study in Korea conducted over 13 years that included 1064 cases of pathologically confirmed PCNs, showed that the incidence of SPN was 18.3% in 2008 [24]. Several large single-institution series on SPN have been reported about in other Asian countries such as Singapore [25], Taiwan [26], India [27], and Japan [28]. "
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    ABSTRACT: Background To investigate the clinicopathological features of surgically resected pancreatic cystic neoplasms (PCNs) at a single institution in China. Methods The medical charts of patients who operated in the Second Affiliated Hospital, Zhejiang University School of Medicine between 1 January 1997 and 30 June 2013, were pathologically shown to have PCNs. Results There was a reliable increase trend not just in the overall number of patients (3 to 75) but additionally in the number of incidentally diagnosed patients across the periods (33.3% to 48.0%). In 83 of 111 cases, preoperative diagnoses matched with pathology, whereas the remaining cases (16/28) were misdiagnosed as pancreatic cancer. The proportion of malignancy in mucin producing neoplasms was 24.3% (9 out of 37). Elevated serum carbohydrate antigen (CA19-9) or carcinoembryonic antigen (CEA) was independently associated with malignancy. The overall survival rate was 96.4%. Conclusions The proportion of PCNs within this series differs with that revealed in Western countries. Appropriate preoperative differential diagnosing of PCNs remains challenging. It is strongly recommended that patients with elevated CA19-9 or CEA levels undergo surgical resection.
    World Journal of Surgical Oncology 07/2014; 12(1):228. DOI:10.1186/1477-7819-12-228 · 1.41 Impact Factor
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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 · 2.68 Impact Factor
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