Abstract
Cystic lesions of the pancreas may range from benign to precursors of pancreatic cancer. Simple mucinous cyst (SMC) is larger than 1 cm, has a gastric-type flat mucinous lining, and minimal atypia without ovarian-type stroma. We report a new case of pancreatic SMC, coupling a systematic review of the English literature mainly focused on their clinic-pathological features. We reviewed 103 cases of SMC in adults (73 women), averaging 57 (range, 26–70) years. The SMCs were located in the body-tail region of the pancreas in 60 (58%) cases, presenting as single cystic lesions in 94% of cases; 43% of patients were asymptomatic. A preoperative fine-needle aspiration of the cyst fluid detected amylase and carcinoembryonic antigen positivity in 71% and 76% of cases, respectively. Patients underwent surgery mostly for suspected malignancy; in 83% of cases, a standard pancreatic resection was performed. Mean SMC size was 4.9 (range, 1.5–12.0) cm. Mucins MUC5AC and MUC6 resulted positive in 77% and 81% of cases performed, respectively, whereas MUC2 was negative in all but one patient. The SMC from our institution was characterized by a KRAS somatic mutation. The diagnosis of SMC should be considered when a solitary pancreatic cyst larger than 1 cm is detected in asymptomatic patients. To establish a correct diagnosis, an extensive histologic/immunohistochemical analysis is essential. The presence of a KRAS mutation highlights that SMC may represent another potential pancreatic cancer precursor.
Highlights
Cystic lesions of the pancreas comprise a wide spectrum of lesions, ranging from benign to pre-neoplastic entities
intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs) have been definitively indicated as precursors of pancreatic ductal adenocarcinoma [2,3,4]
We report a new case of simple mucinous cyst” (SMC) of the pancreas arisen in an adult patient, coupling a systematic review of the English literature mainly focused on their clinic-pathological features
Summary
Cystic lesions of the pancreas comprise a wide spectrum of lesions, ranging from benign to pre-neoplastic entities. Most of the single true cysts of the pancreas have been found in children, in the first few years of life [5] These lesions have been addressed with different terms in the literature. There has been a nomenclature change [6], and the term “simple mucinous cyst” (SMC) has been recommended to describe cysts larger than 1 cm having gastrictype flat mucinous lining and at most minimal atypia without ovarian-type stroma [6].
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