Elsevier

Surgery

Volume 140, Issue 3, September 2006, Pages 448-453
Surgery

Original communication
Intraductal papillary-mucinous neoplasms and mucinous cystic neoplasms of the pancreas differentiated by ovarian-type stroma

https://doi.org/10.1016/j.surg.2006.03.017Get rights and content

Background

Intraductal papillary-mucinous neoplasms (IPMN) and mucinous cystic neoplasms (MCN) of the pancreas have similar clinicopathologic findings. This study was intended to clarify clinicopathologic characteristics in IPMNs and MCNs differentiated by ovarian-type stroma.

Methods

Medical records for 77 patients with pancreatic cystic neoplasms with mucin secretion were reviewed. Patients were divided into IPMN (n = 70) or MCN (n = 7) according to the presence of ovarian-type stroma, and clinicopathologic parameters were compared between groups.

Results

IPMNs consisted of 32 adenomas, 12 borderline neoplasms, 13 adenocarcinomas in situ, and 13 invasive adenocarcinomas; MCNs included 6 adenomas and 1 invasive adenocarcinoma. The mean age of IPMN patients (66 years) was significantly older than that of MCN patients (55 years). The male:female ratio in IPMN (53/17) was significantly greater (P < .001) than in MCN (0/7). The location of the pancreatic mass differed, with 76% 0f IPMNs occurring in the head, while 86% of MCNs occurred in the body or tail. Mass mean size was significantly smaller (28 mm vs 78 mm, P < .001), and mean diameter of the main pancreatic duct was larger (6.8 mm vs 3.1 mm, P < .001) in IPMN than in MCN. Patulous papilla was present in 44% (31/70) of IPMNs, but none was present in MCNs. Communication between the cyst and main pancreatic duct was more frequent in IPMNs (67/70) than in MCNs (1/7). Overall 5-year survival rates were 84% (IPMN) and 100% (MCN).

Conclusions

Clinicopathologic differences between IPMN and MCN are much clearer when differentiated by presence of ovarian-type stroma. Favorable prognosis for both neoplasms is offered by complete resection.

Section snippets

Patients and methods

Patients. Medical records were reviewed retrospectively for 77 patients with pancreatic cystic neoplasm with mucin secretion who were treated at the Department of Surgery, Hiroshima University Hospital, between June 1990 and September 2004. All patients underwent resection of these neoplasms and had a confirmed pathologic diagnosis. Preoperatively, all patients underwent transabdominal ultrasonography and computed tomography. Some patients also underwent endoscopic ultrasonography (EUS, 70

Results

Preoperative characteristics. Among the 70 patients with IPMN were 53 men and 17 women; all 7 patients with MCN were women. MCN patients were younger (P < .001) than IPMN patients. IPMN was located more frequently in the head of the pancreas (76%), while MCN was found in the body and tail of the pancreas in 6 of 7 patients. One patient with MCN arising from the pancreatic head was reported previously.18 Preoperative serum levels of carcinoembryonic antigen and carbohydrate antigen 19-9 did not

Discussion

Many patients with cystic neoplasms called MCNs without ovarian-type stroma have been reported in the literature8, 19, 20 because classification and definition of pancreatic cystic neoplasms with mucin secretion have been unclear. The working group of the Japan Pancreas Society proposed new diagnostic criteria for IPMN and MCN, and performed a multi-institutional, retrospective study of IPMN and MCN in accordance with the new criteria to analyze clinicopathologic features of these neoplasms.8

Conclusion

The clinicopathologic differences between IPMN and MCN become much clearer after differentiation between neoplasm types according to the presence of ovarian-type stroma in the neoplasm. A favorable prognosis is predicted for both neoplasms if they are completely resected before they have progressed to invasive carcinoma.

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