Management of mucinous cystic neoplasms of the pancreas

Abstract

The purpose of this study was to investigate the actual management of mucinous cystic neoplasm (MCN) of the pancreas. A systematic review was performed in December 2009 by consulting PubMed MEDLINE for publications and matching the key words "pancreatic mucinous cystic neoplasm", "pancreatic mucinous cystic tumour", "pancreatic mucinous cystic mass", "pancreatic cyst", and "pancreatic cystic neoplasm" to identify English language articles describing the diagnosis and treatment of the mucinous cystic neoplasm of the pancreas. In total, 16 322 references ranging from January 1969 to December 2009 were analysed and 77 articles were identified. No articles published before 1996 were selected because MCNs were not previously considered to be a completely autonomous disease. Definition, epidemiology, anatomopathological findings, clinical presentation, preoperative evaluation, treatment and prognosis were reviewed. MCNs are pancreatic mucin-producing cysts with a distinctive ovarian-type stroma localized in the body-tail of the gland and occurring in middle-aged females. The majority of MCNs are slow growing and asymptomatic. The prevalence of invasive carcinoma varies between 6% and 55%. Preoperative diagnosis depends on a combination of clinical features, tumor markers, computed tomography (CT), magnetic resonance imaging, endoscopic ultrasound with cyst fluid analysis, and positron emission tomography-CT. Surgery is indicated for all MCNs.

Conduite à tenir devant une tumeur kystique du pancréas

“…Le risque est élevé, supérieur à 20 % justifiant une résection chirurgicale de principe, en fonction du contexte clinique [2,21]. Néanmoins, une série récente a retrouvé un risque plus faible, évalué à 17,5 % (dont 5,5 % de carcinome in situ) [22].…”

“…Cette constatation pourrait remettre en question le dogme de la résec-tion chirurgicale et proposer à l'avenir une surveillance pour les petites lésions de moins de 2 cm ; cette attitude n'est cependant pas validée. Le cystadénome mucineux est plus souvent retrouvé chez la femme (sex ratio : 20/1), avec un âge moyen entre 40 et 50 ans et dans la région corporéocaudale (> 75 %) [21]. Il peut être unique ou multicloisonné, macrokystique dans 80 % ou multiloculaire dans 20 % des cas mais comporte de façon très évocatrice un rehaussement vasculaire des parois que n'a pas le cystadénome séreux [2,[8][9][10].…”

“…La combinaison de la cytologie et d'un ACE > 192 ng/ml est en faveur d'une origine mucineuse de la lésion. La présence d'une calcification pariétale sur le scanner ou d'épaississement de paroi ou de végétation au cours de l'échoendoscopie sont associés à un risque de dégénérescence [8,9,21].…”

Pancreatic Cystic Neoplasms: Diagnosis, Management and Indications for Surgical Procedures. Part II

“…Part II The signs of malignancy are given by: peripheral calcifications, irregular wall, septal thickening, papillary proliferation, intracystic masses, local invasion of surrounding structures and hypervascular appearance (11,12,8). Fine "egg shell" calcifications are rarely visible, only at CT (Fig.…”

Ressecção laparoscópica dos cistoadenomas pancreáticos

“…Although infrequent, and with no specific symptoms, it has been observed an increase in diagnosis of the so called "incidental lesions", mostly because of technological improvement of diagnostic imaging methods. Belongs to this large group of neoplasms, a number of heterogeneous tumors which present very similar clinical and laboratory characteristics, however, with totally different prognosis 23,24 . Cystic lesions of the pancreas may be divided into three groups according to their epithelial lining: 1) no epithelial lining (pseudocysts), 2) presence of epithelial lining (serous cystadenomas and mucinous cystadenomas), 3) presence of degeneration of the epithelial lining or solid lesions (solid-cystic papillary tumors, ductal adenocarcinomas, and neuroendocrine tumors).…”