Mucinous Cystic Neoplasm of the Pancreas is Not an Aggressive Entity

• DOI: 10.1097/sla.0b013e31811f4449
• Publication Date: 2009-03-04T00:36:59Z
• Authors: Stefano Crippa; Roberto Salvia; Andrew L. Warshaw; Ismael Domínguez; Claudio Bassi; Massimo Falconi; Sarah P. Thayer; Giuseppe Zamboni; Gregory Y. Lauwers; Mari Mino-Kenudson; Paola Capelli; Paolo Pederzoli; Carlos Fernández-...
• Keywords: Adenoma; Adult; Aged, 80 and over; Male; Adolescent; Middle Aged; Adenocarcinoma; Mucinous; Adenoma; Adolescent; Adult; Aged; 80 and over; Female; Humans; Male; Middle Aged; Pancreatic Neoplasms; Survival Analysis; Adenocarcinoma, Mucinous; Survival Analysis; 3. Good health; Pancreatic Neoplasms; Humans; Female; Aged

Mucinous cystic neoplasms (MCNs) of the pancreas have often been confused with intraductal papillary mucinous neoplasms. We evaluated the clinicopathologic characteristics, prevalence of cancer, and prognosis of a large series of well-characterized MCNs in 2 tertiary centers.Analysis of 163 patients with resected MCNs, defined by the presence of ovarian stroma and lack of communication with the main pancreatic duct.MCNs were seen mostly in women (95%) and in the distal pancreas (97%); 25% were incidentally discovered. Symptomatic patients typically had mild abdominal pain, but 9% presented with acute pancreatitis. One hundred eighteen patients (72%) had adenoma, 17 (10.5%) borderline tumors, 9 (5.5%) in situ carcinoma, and 19 (12%) invasive carcinoma. Patients with invasive carcinoma were significantly older than those with noninvasive neoplasms (55 vs. 44 years, P = 0.01). Findings associated with malignancy were presence of nodules (P = 0.0001) and diameter > or =60 mm (P = 0.0001). All neoplasms with cancer were either > or =40 mm in size or had nodules. There was no operative mortality and postoperative morbidity was 49%. Median follow-up was 57 months (range, 4-233); only patients with invasive carcinoma had recurrence. The 5-year disease-specific survival for noninvasive MCNs was 100%, and for those with invasive cancer, 57%.This series, the largest with MCNs defined by ovarian stroma, shows a prevalence of cancer of only 17.5%. Patients with invasive carcinoma are older, suggesting progression from adenoma to carcinoma. Although resection should be considered for all cases, in low-risk MCNs (< or =4 cm/no nodules), nonradical resections are appropriate.