Mucinous Cystic Neoplasms Of Pancreas Research Articles

Comparison with surgically resected mucinous cystic neoplasm of pancreas and branch-duct type intraductal papillary mucinous neoplasm considering clinico-radiological high-risk features: a reassessment of current guidelines.

To perform a comparative analysis of surgically resected mucinous cystic neoplasm (MCN) of pancreas and branch-duct type intraductal papillary mucinous neoplasms (BD-IPMN) considering clinico-radiological high-risk predictors for malignant tumors using the current management guidelines. 224 patients who underwent surgical resection and had histopathologically confirmed MCNs (benign 73; malignant 17) or BD-IPMNs (benign 110; malignant 24) and had pre-operative CT or MRI were retrospectively reviewed. Tumors classified as either high-grade dysplasia or invasive carcinoma were considered malignant, whereas those with low-grade dysplasia were considered benign. Imaging features were analyzed by two radiologists based on selected high-risk stigmata or worrisome features proposed by prevalent guidelines except tumors with main pancreatic duct dilatation (> 5mm) were excluded. MCNs and BD-IPMNs showed significant differences in aspects like tumor size, location, the presence and size of enhancing mural nodules, the presence of wall or septal thickening, and multiplicity. Multivariate analyses revealed tumor size (OR, 1.336; 95% CI, 1.124-1.660, p = 0.002) and the presence of enhancing mural nodules (OR, 67.383; 95% CI, 4.490-1011.299, p = 0.002) as significant predictors of malignant MCNs. The optimal tumor size differentiating benign from malignant tumor was 8.95cm, with a 70.6% sensitivity, 89% specificity, PPV of 27.6%, and NPV of 96.9%, demonstrating superior specificity than the guideline-suggested threshold of 4.0cm. For malignant BD-IPMNs, the presence of enhancing mural nodules (OR, 15.804; 95% CI, 4.439-56.274, p < 0.001) and CA 19 - 9 elevation (OR, 19.089; 95%CI, 2.868-127.068, p = 0.002) as malignant predictors, with a size of enhancing mural nodule threshold of 5.5mm providing the best malignancy differentiation. While current guidelines may be appropriate for managing BD-IPMNs, our results showed a notably larger optimal threshold size for malignant MCNs than that suggested by current guidelines. This warrants reconsidering existing guideline thresholds for initial risk stratification and management of MCNs.

Mucinous Cystic Neoplasm of Pancreas: A Rare Case Report

Mucinous Cystic Neoplasm of Pancreas: A Rare Case Report

Laparoscopic Distal Pancreatico-Splenectomy for Mucinous Cystic Neoplasm of Pancreas

Introduction: Mucinous cystic neoplasms are rare premalignant tumors of the pancreas and account for 1–2% of all pancreatic tumors. Surgical removal before invasive malignancy offers the best long-term outcome.1 Distal pancreatectomy with or without spleen preservation remains the standard procedure. Although an open technique is still the most commonly used approach, laparoscopy is associated with less pain, less blood loss, less morbidity, similar clinical outcomes, and an early return to activities.2,3 This video presents a laparoscopic distal pancreaticosplenectomy (LDPS) performed for a mucinous cystic neoplasm in the body of pancreas. Materials and Methods: A 30-year-old lady presented with a 2-year history of recurrent epigastric pain that had increased in severity over the past 2 months and required admission. Her physical examination was normal. A contrast-enhanced computed tomogram revealed a 3 × 3 cm well-defined cystic lesion in the tail of the pancreas adherent to the splenic vein. An endoscopic ultrasonography with fine needle aspirate revealed a complex cystic mucinous cystic neoplasm measuring 2.8 × 2.5 cm in the body of the pancreas. Owing to its premalignant potential and recurrent symptoms, an LDPS was performed for the mucinous cystic neoplasm of the body of pancreas. Vaccinations covering Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae were administered 2 weeks before surgery. The patient was placed in a French position with ports as shown in the video. Spleen preservation was not attempted because of the splenic vein involvement. The pancreas was divided using a stapler and the vessels were divided using sequential clips. The pancreas was separated from the spleen as it was a nonmalignant lesion and enabled easy removal from the port site without enlarging the incision or morcellation. Results: The operative time was 90 minutes with <10 mL of blood loss. The perioperative course was uneventful, and her diet was resumed on postoperative day 1. The drain was removed on postoperative day 3 after an insignificant drain amylase. The patient was discharged on postoperative day 4. Final histopathology report revealed a low-grade mucinous cystic neoplasm of the pancreas. The patient is asymptomatic at 3 months follow-up. Conclusion: LDPS is a safe and feasible approach for mucinous cystic neoplasms of pancreas. It provides less pain, lower blood loss, and early return to work to the patient while providing similar outcomes. The authors have no commercial associations resulting in conflict of interest with respect to the submitted video. Author(s) have received and archived patient consent for video recording/publication in advance of video recording of procedure. Runtime of video: 9 mins 57 secs This video was presented and awarded third best video presentation at SURGICON 2022 (Annual conference of Association of Surgeons of India—Delhi Chapter) on November 13, 2022.

A rare case of serous cyst adenocarcinoma of pancreas with splenic tuberculosis and neuro endocrine deposits in omentum of a young female

Cystic tumours of pancreas with malignant potential are very rare including serous cystic tumour, although mucinous cystic neoplasms of pancreas possess more frequent ability to transmute into mucinous cystadenocarcinoma. Neuroendocrine Tumors (NETs) are rare tumors comprising approximately 2% of all malignancies. The most common sites are gastrointestinal tract and the lung. Most of these tumors are well-differentiated and have an indolent course therefore an incidental finding.

Risk factors of malignant mucinous cystic neoplasm of pancreas and its prognosis

Risk factors of malignant mucinous cystic neoplasm of pancreas and its prognosis

MUCINOUS CYSTADENOMA OF PANCREAS - A INCIDENTAL FINDING WITH CLINICAL SIGNIFICANCE

Cystic neoplasm of pancreas ,a unique entity is gaining its importance due to increased incidence of it's diagnosis .The increased frequency of the diagnosis can be attributed to the heightened usage of the cross sectional imaging such as Computed Tomography ( CT ) and Magnetic Resonance Imaging ( MRI ) .However elucidating the malignant potential of those cysts in a pre operative imaging still remains a challenge and thus a line of demarcation between surveillance and surgery is still undetermined.The differentiation between a serous and mucinous cyst is possible to a certain extent with cross sectional imaging. Mucinous cystic neoplasm carries a high malignant potential compared to the serous neoplasms and hence augmented tissue sampling is required to ascertain malignant potential. Herein presenting a 43 year old female who presented with vague abdominal pain and incidental finding of cystic lesion of the pancreas in Ultrasonography diagnosed with mucinous cystic neoplasm of pancreas in further followup

Risk Factors of Invasive Mucinous Cystic Neoplasm of Pancreas and Its Prognosis

Introduction: Mucinous cystic neoplasm (MCN) of pancreas is a rare pancreatic disease which has potential to become malignant. While early surgical resection of MCN is a mainstay of treatment, radical pancreatic surgery involves high morbidity. The aim of this study was to investigate risk factors of invasive MCN with its prognosis and to establish an appropriate treatment modality for MCN. Methods: From January 2004 to December 2018, a total of 129 patients underwent surgical resection for MCN in Samsung Medical Center, and their clinicopathological data were retrospectively reviewed. Risk factor analyses for recurrence and survival were performed. Results: There were 108 patients in non-invasive group and 21 patients in invasive group. There were more patients with preoperative elevated CA19-9 and mural nodules on preoperative images in invasive group than in non-invasive group (p=0.003 and p=0.003, respectively). In comparison of surgical outcomes, patients who underwent laparoscopic surgery had fewer major complications than those with open surgery (p=0.022). Elevated CA19-9 and mural nodules were independent risk factors for invasive MCNs (p=0.016 and p=0.011, respectively). Patients with invasive MCN showed poorer recurrence-free survival comparing to those with non-invasive MCN (p<0.001), and elevated CA19-9 was an associated factor (p=0.007). Invasive group had worse overall survival (p<0.001), and American Society of Anesthesiologists score and elevated CA19-9 were associated factors (p=0.005 and p=0.005, respectively). Conclusion: Preoperative elevated CA19-9 and mural nodules on image were associated with invasive MCN, which showed poor recurrence-free and overall survival. Surgery should actively be considered in patients with these features.

Mucinous cystic neoplasm of pancreas a case report

Mucinous cystic neoplasm of pancreas are relatively rare &gt;95% occur in the body and tail of pancreas. Majority occur in young and middle aged female containing ovarian type subepithelial stroma. These tumors are either premalignant (MCN with low grade dysplasia) or (MCN with high grade dysplasia) or invasive carcinoma. Differential diagnosis includes pancreatic pseudocyst and pancreatic hydatid cyst. Investigations include ultrasonography (USG), Magnetic resonance imaging (MRI), Contrast enhanced computed tomography (CECT) supplemented by endoscopic USG with cyst fluid aspiration.

Endoscopic Ultrasound-Guided Fine Needle Aspiration Cytologic Evaluation of Intraductal Papillary Mucinous Neoplasm and Mucinous Cystic Neoplasms of Pancreas.

To evaluate the role of endoscopic ultrasound-guided fine needle aspiration cytology in identifying mucinous cystic lesions (MCLs) in histologically proven cases of intraductal papillary mucinous neoplasm (IPMN) or mucinous cystic neoplasm (MCN) and risk of malignancy associated with each cytologic category based on the Papanicolaou Society of Cytopathology (PSC) guidelines. All resected cases with histologic diagnosis of IPMN or MCN at our institution from January 1, 2004, to August 31, 2019, with associated cytology were included. Available cytology slides of nondiagnostic (ND), negative/benign (BN), and atypical cytology (AC) cases were reviewed and reclassified based on the PSC guidelines. A total of 120 cases were identified, including 57 IPMNs with low-grade or moderate dysplasia (LGD/MD) and high-grade dysplasia (HGD), 34 MCNs with LGD/MD or HGD, and 29 IPMNs with invasive malignancy. After cytology slide review and reclassification, we observed that ND and BN cases were paucicellular and lacked ancillary testing (carcinoembryonic antigen levels or KRAS mutation analysis). The risk-of-malignancy rates were 33% for ND, 11% for BN, 28.5% for AC, 17% for MCL, and 100% for suspicious/positive cytologic diagnosis. A multidisciplinary approach including combined use of cytology and ancillary testing is helpful in establishing a diagnosis of MCL and identifying associated malignancy.

Invasive Ductal Carcinoma Arising in Mucinous Cystic Neoplasm of Pancreas: A Case Report

Patient: Female, 40Final Diagnosis: Invasive ductal carcinoma arising in mucinous cystic neoplasm of pancreasSymptoms: NoneMedication: —Clinical Procedure: Surgical resectionSpecialty: OncologyObjective:Rare co-existance of disease or pathologyBackground:Mucinous cystic neoplasm (MCN) of the pancreas is a rare mucin-producing cystic neoplasm that has a characteristic histological feature referred to as ovarian-type stroma (OS) underlying the epithelium. Pancreatic ductal carcinoma arises from MCN as a precursor lesion, but data on progression pathways are limited.Case Report:A 40-year-old female was referred to our hospital for further investigation of a pancreatic cyst. Further examination showed a 7.0 cm multilocular cyst in the pancreatic tail and a solid mass in the thick septum of the cystic tumor. Distal pancreatectomy and splenectomy were performed. Histological examination revealed a moderately differentiated invasive ductal carcinoma (IDC) with a diameter of 0.5 cm in the thick septum of the cystic lesion and a cyst wall composed of epithelium with low-grade to severe dysplasia. The epithelium covered an OS. Pathological diagnosis was IDC arising in MCN of the pancreas. Immunohistochemical examination showed that MUC1 expression was negative in MCN but positive in IDC. KRAS mutation was observed in both MCN and IDC regions.Conclusions:We present a rare case of moderately differentiated pancreatic IDC arising in MCN. To elucidate the underlying progression pathway, we explored the correlation between KRAS mutation and MUC expression as a clinico-pathological parameter.

Retroperitoneal Peripancreatic Colonic Duplication Cyst Can Mimic Mucinous Cystic Neoplasm of Pancreas on Fine Needle Aspiration Cytology

Retroperitoneal Peripancreatic Colonic Duplication Cyst Can Mimic Mucinous Cystic Neoplasm of Pancreas on Fine Needle Aspiration Cytology

A case of mucinous cystic neoplasm of pancreas with melena

A case of mucinous cystic neoplasm of pancreas with melena

Pancreatic hydatid cyst mimicking mucinous cystic neoplasm of pancreas: A case report

Introduction: Isolated hydatid of pancreas is a rare condition, with an incidence of less than 1%. Establishing diagnosis may be difficult because clinical and imaging findings are similar to other more commonly encountered cystic lesions of pancreas. We present a case of isolated Hydatid cyst in the tail of pancreas which mimicked a mucinous cystic neoplasm on imaging. Case report: A 33 y old male presented with Pain in left lumbar region for 10 days. Investigations showed a normal blood profile. CECT abdomen showed a cystic lesion in tail of pancreas with internal septations and rim calcification suggestive of Mucinous cystadenocarcinoma of pancreas. Patient underwent Distal pancreatectomy and Splenectomy. Histopathological examination was reported as Hydatid cyst of pancreas. Patient was followed up with 3 week course of Albendazole therapy. Conclusion: Hydatid is a zoonotic disease caused by Echinococcus granulosus. The most common location is Liver followed by Lung. Isolated hydatid of pancreas is a rare entity described in literature. The most clinically significant feature of pancreatic hydatid is their rarity and their presenting features which may masquerade as pseudocysts or cystic neoplasms. Preoperative diagnosis may be difficult even with modern imaging techniques. A definitive diagnosis can be made only at surgery and on histopathology. A Hydatid cyst in the tail of the pancreas can be successfully treated with a Distal pancreatectomy .To avoid major pancreatic resections due to a mistaken diagnosis of pancreatic malignancy, pancreatic hydatid should be considered in the differential diagnosis of pancreatic cystic lesions, especially in endemic regions.

Mucinous Cystic Neoplasm of Pancreas With Intermediate-Grade Dysplasia

Mucinous Cystic Neoplasm of Pancreas With Intermediate-Grade Dysplasia

Mucinous cystic neoplasms of pancreas: an analysis of 42 patients

Objective To study the clinicopathological characteristics,diagnosis and treatment of patients with mucinous cystic neoplasms (MCNs) of the pancreas.Methods The clinical data of 42 patients with mucinous cystic neoplasms of pancreas were retrospectively analyzed.Chi-square test and independent sample t-test were used for statistical analysis.Results The mean age of the patients was 53.1 yeas (ranged from 29 to 78 y).There were 32 female (76.2％).The patients were divided into two groups according to symptoms (the symptomatic group and the asymptomatic group).There were significant differences in tumor size,tumor location,operation type,operation time and adhesions with the surrounding tissues between the 2 groups of patients.The patients were then divided into three groups according to pathological type.There were significant differences in age,tumor marker,tumor location,operation type,operation time,adhesions with the surrounding tissues,operative blood loss,and postoperative hospital stay among the 3 groups of patients.There was no tumour recurrence in the patients with cystadenoma.Patients with cystadenocarcinoma developed tumor recurrence at a mean of 16.4 months (range,0-50) and died of tumor recurrence even after radical surgery at a mean of 22.9 months (range,3-58).Conclusion MCNs were seen most commonly in middleaged women.The presence of symptoms was a sign of malignancy.Resection of the tumor in the early stage is the key in dealing with MCNs. Key words: Pancreatic neoplasms; Histology; Treatment outcome

Pancreatic mucinous cystic neoplasm with sarcomatous stroma metastasizing to liver: a case report and review of literature

We report a case of mucinous cystic neoplasm of pancreas with sarcomatous stroma metastasizing to the liver. The tumor occurred in a male patient aged 46 years. Symptoms included persistent epigastric and right upper quadrant pain. Radiographically, the pancreas contained four large cystic masses located in the neck, body, and tail. Histologically, the cysts were lined with benign, mucinous epithelium with underlying bland, storiform, ovarian-like stroma. An undifferentiated focally hyalinized, sarcomatous stroma composed of bland spindle cells showing short fascicular growth pattern and focal nuclear palisading was associated with the epithelial component in one of the cysts. These cells showed strong immunoreactivity with vimentin and inhibin (weak), they were negative for CD34, estrogen receptor, progesterone receptor, androgen, calretinin, S-100, CD117, melan A, chromogranin, and synaptophysin. A morphologically and immunohistochemically identical metastatic sarcomatous focus was identified in the liver without any glandular component. This case is unique in its clinically malignant behaviour and metastatic nature despite its morphologically benign epithelial and stromal components.

Giant mucinous cystic neoplasms of pancreas and liver with unusual adipose tissue component: a case report.

Simultaneous occurrence of pancreatic and hepatic mucinous cystic neoplasms is very rarely reported in the literature. We present a case with extensive fatty component of the pancreatic tumour arising from the head of the pancreas and attaining a huge size before being treated by Whipple's pancreatoduodenectomy and subsequently by a right hepatectomy for the hepatic tumour.

F-18 FDG Accumulation in Mucinous Cystic Neoplasm of Pancreas

We report a case of mucinous cystic neoplasm which showed FDG accumulation in its cyst wall. MRI revealed that this tumor had repeated intracystic hemorrhage. Inhomogeneous FDG accumulation was found in the cyst wall. The epithelium was focally denuded and ovarian-like stroma with macrophage migration, which phagocytosed red blood cells, and fibrosis were recognized on histopathological examination. These histopathological findings suggested that FDG accumulates not in the monolayer epithelium but in ovarian-like stroma with macrophage migration and fibrosis. Macrophage migration and fibrosis were considered to have contributed to FDG accumulation in this mucinous cystic neoplasm.

Distinctive immunohistochemical profile of mucinous cystic neoplasms of pancreas, ovary and lung.

Mucinous cystic neoplasms (MCNs) of the pancreas, ovary and lung have a similar histologic appearance. We investigated if immunohistochemical (IHC) studies could help in separating these neoplasms. Twenty-six ovarian MCNs (invasive carcinoma and borderline tumor), 12 pancreatic MCNs (invasive carcinoma, and with moderate or high-grade dysplasia), and 3 pulmonary MCNs (only invasive carcinoma) were retrieved. Our study demonstrated that pancreatic MCNs are positive for CDX-2 (67%), PDX-1 (100%), CK7 (83%) and CK20 (100%), while are negative for CA-125. The IHC profile of ovarian intestinal type MCN is similar to that of pancreatic MCNs, except for lower frequency of CDX-2 expression (29% vs. 67%). Ovarian endocervical like MCNs are positive for CA-125 (100%) and CK7 (100%), while are negative for CDX-2, PDX-1 and CK20. Pulmonary MCNs are positive for CDX-2 (100%), CK7 (100%) and CK20 (100%), while are negative for PDX-1 and CA-125. All tumors are negative for TTF-1, D2-40 and WT-1. We concluded that an IHC panel of CDX-2, PDX-1, CA-125, and CK20 is useful in separating MCNs of the pancreas, ovary and lung.

An Extremely Rare Cause of Acute Abdomen in Pregnancy

Pancreatic cystadenocarcinoma is an extremely rare neoplasm in pregnancy. To our knowledge, there have been 2 published cases of pancreatic mucinous cystadenocarcinoma (PMC) during pregnancy in the literature; one of which was reported to have ruptured into the abdominal cavity. We present a second case of ruptured PMC resulting in acute abdomen in 36 weeks of pregnancy. Rupture of mucinous cystic neoplasms of pancreas including PMC should be remembered in acute abdomen during pregnancy.