Top

Published in:

01-12-2006

A Review of Mucinous Cystic Neoplasms of the Pancreas Defined by Ovarian-type Stroma: Clinicopathological Features of 344 Patients

Authors: Brian K. P. Goh, MBBS, MMed (Surgery), MRCS, Yu-Meng Tan, BSc (Hons), MBBS, FRCS, Yaw-Fui A. Chung, MBBS, FRCS, Pierce K. H. Chow, MBBS, FRCS, PhD, Peng-Chung Cheow, MBBS, FRCS, Wai-Keong Wong, MBBS, FRCS, London L. P. J. Ooi, MBBS, FRCS, MD

Published in: World Journal of Surgery | Issue 12/2006

Abstract

Introduction

Despite formal definitions of mucinous cystic neoplasms (MCNs) and intraductal papillary neoplasms (IPMNs) by the World Health Organization (WHO) and Armed Forces Institute of Pathology (AFIP), several controversies with regard to MCNs remain. The aim of this review was to determine the clinicopathological features of MCNs defined by ovarian-type stroma (OS) as proposed by the WHO and AFIP and to compare them with MCNs defined by less stringent criteria.

Methods

A MEDLINE search was conducted to identify English-language articles on pancreatic MCNs from 1996 to 2005. Twenty-five studies were identified. The studies were divided into 2 groups: group A included 10 studies with 344 patients whereby the presence of OS was a criteria for the diagnosis of MCNs, and group B, included 15 studies comprising 761 patients whereby the presence of OS was not mandatory for the diagnosis of MCNs.

Results

Patients in group A (MCNs as defined by OS) were almost always female (99.7%), with a mean age of 47 (range, 18–95) years. MCNs were located predominantly in the body or tail of the pancreas (94.6%) and had a mean size of 8.7 cm (range, 0.6–35 cm); 76% were symptomatic, 6.8% demonstrated ductal communication, and 27% were malignant. At a mean follow-up of 57.5 (range, 1–264) months and 43 (range, 2–257) months after surgery, 97.9% of benign and 61.9% of malignant neoplasms were disease free, respectively. Patients in group B were older and had a higher proportion of males. Neoplasms were more evenly distributed in the pancreas, were smaller, communicated more frequently with the pancreatic duct, and were composed of a higher proportion of malignant tumors compared with group A. Their clinicopathological features were intermediate between those of group A and patients with IPMN.

Conclusion

Pancreatic MCNs with OS have unique and distinct clinicopathological features. MCNs should be defined by the presence of OS, as it is the most reliable way of distinguishing MCNs from IPMN. Adoption of “looser” criteria will result in misclassification of some IPMNs as MCNs.

Compagno J, Oertel JE. Microcystic adenomas of the pancreas. Glycogen-rich cystadenomas. Am J Clin Pathol 1978;69:281–298

Compagno J, Oertel JE. Mucinous cystic neoplasms of the pancreas with overt and latent malignancy (cystadenocarcinoma and cystadenoma). A clinicopathologic study of 41 cases. Am J Clin Pathol 1978;69:573–580PubMed

Kloppel G, Solcia E, Longnecker DS, et al. World Health Organization international classification of tumours. Histological typing of tumors of the exocrine pancreas. 2nd edn. Springer, Berlin Heidelberg New York, 1996:1–61

Solcia E, Capella C, Kloppel G. Tumors of the pancreas. In: Rosai J, Sobin LH, editors. Atlas of Tumor Pathology. Fascicle 20. 3rd Series. Armed Forces Institute of Pathology, Washington, DC, 1997

Goh BK, Tan YM, Cheow PC, et al. Cystic neoplasms of the pancreas with mucin–production. Eur J Surg Oncol 2005;31:282–287PubMedCrossRef

Fukushima N, Mukai K, Kanai Y, et al. Intraductal papillary tumors and mucinous cystic tumors of the pancreas: clinicopathologic study of 38 cases. Hum Pathol 1997;28:1010–1017PubMedCrossRef

Zamboni G, Scarpa A, Bogina G, et al. Mucinous cystic tumors of the pancreas: clinicopathologic feature, prognosis, and relationship to other mucinous cystic tumors. Am J Surg Pathol 1999;23:410–422PubMedCrossRef

Thompson LD, Becker RC, Przygodzki RM, et al. Mucinous cystic neoplasm (mucinous cystadenocarcinoma of low–grade malignant potential) of the pancreas: a clinicopathologic study of 130 cases. Am J Surg Pathol 1999;23:1–16PubMedCrossRef

Shimizu Y, Yasui K, Yamao K, et al. Possible oncogenesis of mucinous cystic tumors of the pancreas lacking ovarian-like stroma. Pancreatology 2002;2:413–420PubMedCrossRef

10.

Hara T, Kawashima H, Ishigooka M, et al. Mucinous cystic tumors of the pancreas. Surg Today 2002;32:965–969PubMedCrossRef

11.

Izumo A, Yamaguchi K, Eguchi T, et al. Mucinous cystic tumor of the pancreas: immunohistochemical assessment of ‚ovarian-type stroma’. Oncol Rep 2003;10:515–525PubMed

12.

Kosmahl M, Pauser U, Peters K, et al. Cystic neoplasms of the pancreas and tumor-like lesions with cystic features: a review of 418 cases and a classification proposal. Virchows Arch 2004;445:168–178PubMedCrossRef

13.

Reddy RP, Smyrk TC, Zapiach M, et al. Pancreatic mucinous cystic neoplasm defined by ovarian stroma: demographics, clinical features, and prevalence of cancer. Clin Gastro Hepatol 2004;2:1026–1031PubMedCrossRef

14.

Sawai H, Okada Y, Funahashi H, et al. Immunohistochemical analysis of molecular biological factors in intraductal papillary-mucinous tumors and mucinous cystic tumors of the pancreas. Scand J Gastroenterol 2004;11:1159–1165CrossRef

15.

Yeh MM, Tang LH, Wang S, et al. Inhibin expression in ovarian-type stroma in mucinous cystic neoplasms of the pancreas. Appl Immunohistochem Mol Morphol 2004;12:148–152PubMed

16.

Shyr YM, Su CH, Tsay SH, Lui WY. Mucin-producing neoplasms of the pancreas: intraductal papillary and mucinous cystic neoplasms. Ann Surg 1996;223:141–146PubMedCrossRef

17.

Sugiyama M, Atomi Y, Kuroda A. Two types of mucin-producing cystic tumors of the pancreas: diagnosis and treatment. Surgery 1997;122:617–625PubMedCrossRef

18.

Wilentz RE, Albores-Saavedra J, Zahurak M, et al. Pathologic examination accurately predicts prognosis in mucinous cystic neoplasms of the pancreas. Am J Surg Pathol 1999;23(11):1320–1327PubMedCrossRef

19.

Le Borgne J, de Calam L, Partensky C. The French Surgical Association. Cystadenomas and cystadenocarcinomas of the pancreas: a multiinstituitional retrospective study of 398 cases. Ann Surg 1999;23:152–161CrossRef

20.

Scott J, Martin I, Redhead D, et al. Mucinous cystic neoplasms of the pancreas: imaging features and diagnostic difficulties. Clin Radiol 2000;55:187–192PubMedCrossRef

21.

Sarr MG, Carpenter HA, Prabhakar LP, et al. Clinical and pathologic correlation of 84 mucinous cystic neoplasms of the pancreas. Can one reliably differentiate benign from malignant (or premalignant) neoplasms? Ann Surg 2000;231(2):205–212PubMedCrossRef

22.

Shima Y, Mori M, Takakura N, et al. Diagnosis and management of cystic pancreatic tumours with mucin production. Br J Surg 2000;87:1041–1047PubMedCrossRef

23.

Yamaguchi K, Yokohata K, Noshiro H, et al. Mucinous cystic neoplasm of the pancreas or intraductal papillary mucinous tumor of the pancreas. Eur J Surg 2000;166:141–148PubMedCrossRef

24.

Fujino Y, Suzuki Y, Ajiki T, et al. Surgical treatment for mucin-producing tumors of the pancreas. Hepatogastroenterology 2001;48:1157–1161PubMed

25.

Yeh TS, Jan YY, Chiu CT, et al. Characterisation of oestrogen receptor, progesterone receptor, trefoil factor 1, and epidermal growth factor and its receptor in pancreatic cystic neoplasms and pancreatic ductal carcinoma. Gut 2002;51:712–726PubMedCrossRef

26.

Kim SG, Wu TT, Lee JH, et al. Comparison of epigenetic and genetic alterations in mucinous cystic neoplasm and serous microcystic adenoma of pancreas. Mod Pathol 2003;16:1086–1094PubMedCrossRef

27.

Suzuki Y, Atomi Y, Sugiyama M, et al. Cystic neoplasm of the pancreas. A Japanese multiinsitutional study of intraductal papillary mucinous tumor and mucinous cystic tumor. Pancreas 2004;28 (3):241–246PubMedCrossRef

28.

Warshaw AL, Compton CC, Lewandrowski K, et al. Cystic tumors of the pancreas. New clinical, radiologic, and pathologic observations in 67 patients. Ann Surg 1990;212:432–445PubMedCrossRef

29.

Angelica D’ M, Brennan MF, Suriawinata AA, et al. Intraductal papillary mucinous neoplasms of the pancreas: an analysis of clinicopathologic features and outcome. Ann Surg 2004;239:400–408PubMedCrossRef

30.

Salvia R, Fernandez-del Castillo C, Bassi C, et al. Main-duct intraductal papillary mucinous neoplasms of the pancreas: clinical predictors of malignancy and long-term survival following resection. Ann Surg 2004;239:678–685PubMedCrossRef

31.

Sohn TA, Yeo CJ, Cmaeron JL, et al. Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Ann Surg 2004;239:788–797PubMedCrossRef

32.

Wada K, Korazek RA, Traverso WL. Outcome following resection of invasive and non-invasive intraductal papillary mucinous neoplasms of the pancreas. Am J Surg 2005;189:632–636PubMedCrossRef

33.

Jang JY, Kim SW, Ahn YJ, et al. Multicenter analysis of clinicopathologic features of intraductal papillary mucinous tumor of the pancreas: is it possible to predict the malignancy before surgery? Ann Surg Oncol 2005;12:124-132PubMedCrossRef

34.

Sugiyama M, Atomi Y. Recent topics in mucinous cystic tumor and intraductal papillary mucinous tumor of the pancreas. J Hepato Pancreat Surg 2003;10:123–124CrossRef

35.

Tanaka M, Chari S, Adsay V, et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 2006;6:17–32PubMedCrossRef

36.

Wheeler DA, Edmondson HA. Cystadenoma with mesenchymal stroma in the liver and bile ducts. Cancer 1985;56:1434–1445PubMedCrossRef

37.

Gui L, Bigler SA, Subramony C. Lymphangioma of the pancreas with “ovarian-like” mesenchymal stroma. Arch Pathol Lab Med 2003;127:1513–1516PubMed

38.

Devaney K, Goodman ZD, Ishak KG. Hepatobiliary cystadenoma and cystadenocarcinoma: a light microscope and immunohistochemical study of 70 cases. Am J Surg Pathol 1994;18:1078–1091PubMedCrossRef

39.

Wenig B, Albores-Saavedra J, Buetow PC, et al. Pancreatic mucinous neoplasm with sarcomatous stroma. A report of three cases. Am J Surg Pathol 1997;21 (1):70–80PubMedCrossRef

40.

Suyama Y, Horte Y, Suou T. Oral contraceptives and intrahepatic biliary cystadenoma having an increased level of estrogen receptor. Hepatogastroenterologica 1988 ;35:171–174PubMed

41.

Suzuki M, Fujita N, Onodera H, et al. Mucinous cystic neoplasm in a young male patient. J Gastroenterol 2005;40:1070-1074PubMedCrossRef

42.

Goh BK, Tan YM, Kumarasinghe MP, et al. Mucinous cystic tumor of the pancreas with ovarian-like mesenchymal stroma in a male patient. Dig Dis Sci 2005;50:2170–2177PubMedCrossRef

43.

Wouters K, Extors N, Van Steenbergen W, et al. A pancreatic mucinous cystadenoma in a man with mesenchymal stroma, expressing oestrogen and progesterone receptors. Virchows Arch 1998;432:187–189PubMedCrossRef

44.

Yamao K, Nakamura T, Suzuki T, et al. Endoscopic diagnosis and staging of mucinous cystic neoplasms and intraductal papillary mucinous tumors. J Hepatobiliary Pancreat Surg 2003;10:142–146PubMedCrossRef

45.

Wilentz RE, Albores-Saavedra J, Hruban RH. Mucinous cystic neoplasms of the pancreas. Semin Diagn Pathol 2000;17:31–42PubMed

Title: A Review of Mucinous Cystic Neoplasms of the Pancreas Defined by Ovarian-type Stroma: Clinicopathological Features of 344 Patients
Authors: Brian K. P. Goh, MBBS, MMed (Surgery), MRCS
Yu-Meng Tan, BSc (Hons), MBBS, FRCS
Yaw-Fui A. Chung, MBBS, FRCS
Pierce K. H. Chow, MBBS, FRCS, PhD
Peng-Chung Cheow, MBBS, FRCS
Wai-Keong Wong, MBBS, FRCS
London L. P. J. Ooi, MBBS, FRCS, MD
Publication date: 01-12-2006
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 12/2006
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-006-0126-1

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

A Review of Mucinous Cystic Neoplasms of the Pancreas Defined by Ovarian-type Stroma: Clinicopathological Features of 344 Patients

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 12/2006

Survival of Early Gastric Cancer in a Specialized European Center. Which Lymphadenectomy Is Necessary?

Reply—Correlations between Vitamin D Status and Biochemical/Clinical and Pathological Parameters in Primary Hyperparathyroidism

Impact of Cuffed, Expanded Polytetrafluoroethylene Dialysis Grafts on Graft Outlet Stenosis

Invited Commentary on The Analysis of Infection after Polypropylene Mesh Repair of Abdominal Wall Hernia

Effect of Glucocorticoid Pretreatment on Oxidative Liver Injury and Survival in Jaundiced Rats with Endotoxin Cholangitis

Lessons Learned from Initial Experience with Peritonectomy and Intra-peritoneal Chemotherapy Infusion