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: Background and study aims: Intraductal papillary mucinous neoplasm (IPMN) consists of four epithelial subtypes. There are limited data on the endoscopic ultrasound (EUS) findings and/or cyst fluid analysis of the epithelial subtypes. The objective of this study was to determine whether there are differences in EUS and cyst fluid characteristics (carcinoembryonic antigen [CEA] concentration and cytology) among the subtypes. Patients and methods: The study cohort consisted of 85 patients (median age 68 years, 40 men) with resected and histologically confirmed branch-duct or mixed-type IPMNs who underwent preoperative EUS-guided fine-needle aspiration between 1999 and 2010 for the evaluation of pancreatic cysts. EUS and cyst fluid characteristics were analyzed retrospectively and correlated with the subtypes. Results: The numbers of evaluated cystic lesions were 1 in 79 patients, 2 in 5 patients, and 3 in 1 patient. Of 92 IPMNs analyzed, gastric-type IPMNs were the most common (n = 68, 73.9 %), followed by intestinal (n = 17, 18.5 %), oncocytic (n = 5, 5.4 %), and pancreatobiliary subtypes (n = 2, 2.2 %). Gastric-type IPMNs were significantly smaller (cutoff 30 mm; P = 0.002), and less likely than other subtypes to have a mass lesion or mural nodule (P = 0.046) on EUS. Cyst fluid CEA concentration varied among the subtypes (median concentrations for gastric, intestinal, oncocytic, and pancreatobiliary types 619.8, 83.0, 5.1, and 270.0 ng/mL, respectively; P = 0.012). The presence of neoplastic epithelial cells (P = 0.624) and extracellular mucin (P = 0.208) on cytology had no association with subtypes. Conclusions: Gastric-type IPMNs, the most common subtype, are characterized by high concentrations of cyst fluid CEA, small cyst diameter, and low risk EUS imaging features.Endoscopy 09/2014; 46(12). DOI:10.1055/s-0034-1377629 · 5.20 Impact Factor
Article: Pancreatic Cystic Neoplasms[Show abstract] [Hide abstract]
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.08/2014; 6(8):413-7. DOI:10.4103/1947-2714.139298
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ABSTRACT: BackgroundTo investigate the clinicopathological features of surgically resected pancreatic cystic neoplasms (PCNs) at a single institution in China.MethodsThe 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.ResultsThere 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%.ConclusionsThe 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 · 1.20 Impact Factor