Mini-SymposiumOverview of the clinical problem: Facts and current issues of mucinous cystic neoplasms of the pancreas
Introduction
Tumours of the pancreas generally have a poor prognosis, with the majority being highly malignant. Although cystic lesions of the pancreas are uncommon, pancreatic cystic neoplasms are currently increasingly being diagnosed, probably because of the wider availability of imaging procedures.
Many patients are asymptomatic (up to 40–75%), with the cystic mass discovered only incidentally during diagnostic investigation of unrelated upper abdominal symptoms. When a patient is symptomatic, the presentation is usually non-specific and related to the mass effect of the neoplasm [1].
Four types of cystic neoplasms of the pancreas have been described, i.e., (1) serous neoplasms, (2) mucinous neoplasms, (3) intraductal papillary cystic neoplasms and (4) papillary cystic neoplasms [2], [3], [4], [5]. The cells of origin of the different types of pancreatic cystic neoplasms and their biologic aggressiveness vary tremendously and therefore need a selective management approach [1]. In this review we present an overview of the clinical problems of cystic neoplasms of the pancreas, with specific emphasis on mucinous pancreatic neoplasms.
Section snippets
Epidemiology
Mucinous cystic neoplasms (MCNs) of the pancreas are relatively rare and occur predominantly in women. Nonetheless, MCNs represent 40–50% of cystic neoplasms of the pancreas. MCNs cover 10–15% of pancreatic cysts and mucinous cystadenocarcinomas 1% of pancreatic neoplasms in the US [1], [3], [5], [6], [7], [8]. Patient ages range widely (35–90 years), with an average that seems to depend on the degree of malignancy of the neoplasm. Patients with mucinous cystadenocarcinomas appear to be
Epidemiology
IPMNs, first described by Ohashi et al. [20], occur most frequently in the sixth and seventh decades of life (range 30–94 years), originally affecting males more often than females (ratio 2.2:1), however more recent reports show an equal gender distribution [2], [21], [22], [23], [24]. A retrospective study from Asia found a male predominance, which raises the question of whether or not geographic factors are involved in the pathogenesis of IPMNs. IPMNs account for less than 10% of all
Epidemiology
SCNs are generally benign [2], [6], [39]. These neoplasms mainly occur in women in their 50s (65%) and represent approximately 30% of primary cystic neoplasms of the pancreas [2], [3], [11], [40]. SCNs are most frequently detected in the head of the pancreas (>50%) and have a mean size of approximately 7 cm [1], [2], [3].
Clinical presentation
The most frequently reported symptoms are abdominal discomfort and low-grade pain. Weight loss, palpable mass, jaundice and obstruction of the upper gastrointestinal tract are
Current issues
A number of issues regarding pancreatic cystic neoplasms are still under debate and require further study.
First, although imaging techniques are improving and the awareness of these cystic neoplasms is high, differentiation between SCNs, MCNs and IPMNs is still difficult and the possibility of misdiagnosing is as high as 10%. Differentiation between serous and mucinous neoplasms is important, because the latter is potentially malignant. Guidelines may help to differentiate between SCNs, MCNs
Conclusion
Cystic neoplasms are currently increasingly being diagnosed, because of a wider variety in imaging techniques. MCNs and IPMNs have a malignant potential, whereas SCNs are generally benign. Differentiation between benign, premalignant and malignant neoplasms is of great importance, because treatment and prognosis is highly dependent on these characteristics. CT seems to be the examination of choice for a correct prediction of tumour type. High concentrations of CEA may differentiate mucinous
Conflicts of interest
None declared.
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