Growth pattern of serous cystic neoplasms of the pancreas: observational study with long-term magnetic resonance surveillance and recommendations for treatment

Abstract

Overall, SCNs grow slowly, and an initial non-operative approach is feasible in all the asymptomatic or minimally symptomatic patients. The oligocystic/macrocystic variant, a history of other non-pancreatic malignancies and patients' age impact on tumour growth. In any case, a significant growth is unlikely to occur before 7 years from the baseline evaluation. Tumour size at the time of diagnosis should not be used for decisional purposes.

Cystic Neoplasms of the Pancreas

“…Side-branch (SB-IPMN) and mixed type IPMN are usually multiloculated lesions that can be thought of as mimicking a cluster of grapes. This is in contrast to SCA in which approximately 58 % have a classic microcystic morphology 8,15 ( Fig. 2) that is similar to the appearance of a sliced orange.…”

“…A recent study has assessed the rate of growth of SCA in 145 patients. 15 The rate of growth was found to be smaller (0.1 cm/year) in the first 7 years compared to the subsequent period (0.6 cm/year). 15 More rapid tumor growth was associated with macrocystic SCA and increased age.…”

“…15 The rate of growth was found to be smaller (0.1 cm/year) in the first 7 years compared to the subsequent period (0.6 cm/year). 15 More rapid tumor growth was associated with macrocystic SCA and increased age. Our protocol at Johns Hopkins is for yearly cross-sectional imaging on presumed SCA.…”

“…14 Even in patients with metastatic diseases, prognosis remains good with only 18.2 % of patients with metastases dying with a mean follow-up of 6.3 years (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. 31 Postoperative surveillance is normally performed with cross-sectional imaging every 6 months for 2 years and then annually for a total of 5 years.…”

Cystic Neoplasm of the Pancreas

“…Particular attention should be paid to patients with oligocystic/ macrocystic variant, with a medical history of nonpancreatic malignancies, and for elderly patients because of the faster growth pattern that has been shown in these cases [8]. Once a surgical indication exists, minimally invasive technique should be taken into account, even though SCNs requiring surgery are of giant dimensions in several cases.…”