Microcystic Adenoma Associated with a Mucinous Cystadenocarcinoma: A “Collision Tumor” of the Pancreas (original) (raw)
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The American Journal of Surgical Pathology, 1999
Mucinous cystic naopIasms (MCNs) of the p c r e a s are uncommon tumors. The classifntion and biologic potential of these neoplasms n m a h the subject of controversy. Attempts to classify t h~ tumors in a sirnilat manner to ovarian MCNs remains controversial, as even ~t o l o g i d y bmignappe.amg pmcrealic MCNs metastasize and art IethaI. One hundred cases of MCNs were identXed in the files of the trine Pathology Tumor R c w of the Armed P m s Institute of PathoIogy from the YCBF~ 1979 to 1993. The pathologic features, including hematoxylin and Basin s w n g , bistochemishy, i m m u 1 1~h e m i s k y (XHC), ocll cycle analysis, and K-ms oncogene detamhation were review&. These finwere correlated with the clinical follow-up obtained in all cases. There were 130 women, aged 2 M 5 years (mean age at the outset, 44.6 y w ) . Tbt m t s had vague abdominal pain, fullness, or abdominal masses. More than 95% of the tumors were in the m c tail or body and were p d o m h n t l y m u l t i l~. The tumors xanged in size from 1.5 to 36 cm in greatest dimension, with the average tumor measuring >I0 cm. A specttum of hbtomorphologic changes were present within the same case and from case to we. A single layer of blandappearing, sialomucin-producing columnar epithelium Iining the cyst wall wouId abruptly change to a complex papillary architecture, with and without cytologic atypia, and with and without s t c o d invasion. Ovarian-type smma was a c b teristic and requisite f e w . Focal sclerotic hyalhhtion of the siroma was noted. This ovarian-type smma reacted with *nth, smooth muscle actin, progesterone, w cstmgen re-From the -t of E d m h e and OtorJholaryn@c-Head & Neck Pathology &D.RT., C F . k , CS-H), the -t ofC?IlW Pathology, Mole& Division (RMP.). and the Deparment of Cellular Pathology, Division of Quantitative Pathology (R.C.B.), ArmGd Forces Mtute of Pathology, Washington, DC. Address ~~c e and reprint quests to Dr. Lester D.R Thompson, Dcpammt of Bndocrint and OtorhinohyngmBd & Nezk Pathology, BuMmg 54, Room GO661 1, hmd Forcss Institute of Pathology, 6825 16th Sh-cct NW, Washugmi, DC 2M066000, U.S.A. h n t e d at the 86th Annual Metting of tbe United Stares d Can a a n Academy of PaihoIogy, Orlando, FIoria March 1-8, 1997.
The American Journal of Surgical Pathology, 1999
Mucinous cystic naopIasms (MCNs) of the p c r e a s are uncommon tumors. The classifntion and biologic potential of these neoplasms n m a h the subject of controversy. Attempts to classify t h~ tumors in a sirnilat manner to ovarian MCNs remains controversial, as even ~t o l o g i d y bmignappe.amg pmcrealic MCNs metastasize and art IethaI. One hundred cases of MCNs were identXed in the files of the trine Pathology Tumor R c w of the Armed P m s Institute of PathoIogy from the YCBF~ 1979 to 1993. The pathologic features, including hematoxylin and Basin s w n g , bistochemishy, i m m u 1 1~h e m i s k y (XHC), ocll cycle analysis, and K-ms oncogene detamhation were review&. These finwere correlated with the clinical follow-up obtained in all cases. There were 130 women, aged 2 M 5 years (mean age at the outset, 44.6 y w ) . Tbt m t s had vague abdominal pain, fullness, or abdominal masses. More than 95% of the tumors were in the m c tail or body and were p d o m h n t l y m u l t i l~. The tumors xanged in size from 1.5 to 36 cm in greatest dimension, with the average tumor measuring >I0 cm. A specttum of hbtomorphologic changes were present within the same case and from case to we. A single layer of blandappearing, sialomucin-producing columnar epithelium Iining the cyst wall wouId abruptly change to a complex papillary architecture, with and without cytologic atypia, and with and without s t c o d invasion. Ovarian-type smma was a c b teristic and requisite f e w . Focal sclerotic hyalhhtion of the siroma was noted. This ovarian-type smma reacted with *nth, smooth muscle actin, progesterone, w cstmgen re-From the -t of E d m h e and OtorJholaryn@c-Head & Neck Pathology &D.RT., C F . k , CS-H), the -t ofC?IlW Pathology, Mole& Division (RMP.). and the Deparment of Cellular Pathology, Division of Quantitative Pathology (R.C.B.), ArmGd Forces Mtute of Pathology, Washington, DC. Address ~~c e and reprint quests to Dr. Lester D.R Thompson, Dcpammt of Bndocrint and OtorhinohyngmBd & Nezk Pathology, BuMmg 54, Room GO661 1, hmd Forcss Institute of Pathology, 6825 16th Sh-cct NW, Washugmi, DC 2M066000, U.S.A. h n t e d at the 86th Annual Metting of tbe United Stares d Can a a n Academy of PaihoIogy, Orlando, FIoria March 1-8, 1997.
Mucinous Cystic Neoplasm of the Pancreas is Not an Aggressive Entity
Annals of Surgery, 2008
Objective-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. Methods-Analysis of 163 patients with resected MCNs, defined by the presence of ovarian stroma and lack of communication with the main pancreatic duct. Results-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 ≥60 mm (P = 0.0001). All neoplasms with cancer were either ≥40 mm in size or had nodules. There was no operative mortality and postoperative morbidity was 49%. Median followup was 57 months (range, 4-233); only patients with invasive carcinoma had recurrence. The 5year disease-specific survival for noninvasive MCNs was 100%, and for those with invasive cancer, 57%. Conclusions-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 (≤4 cm/no nodules), nonradical resections are appropriate. Mucinous cystic neoplasms (MCNs) usually are large, septated, thick-walled mucinous cysts that lack communication with the ductal system, and occur almost exclusively in the
Mucinous cystic neoplasm of the pancreas in a male patient
Rare tumors, 2011
Mucinous cystic neoplasms (MCNs) make up a morphologic family of similar appearing tumors arising in the ovary and various extraovarian organs such as pancreas, hepatobiliary tract and mesentery. MCNs of the pancreas occur almost exclusively in women. Here, we report a rare case of MCN in a male patient. A 39-year-old man was admitted to our hospital with the chief complaint of back pain. Abdominal computed tomography revealed a multilocular cyctic mass 6.3 cm in diameter in the pancreatic tail. In addition, the outer wall and septae with calcification were demonstrated in the cystic lesion. On magnetic resonance imaging , the cystic fluid had low intensity on T1-weighted imaging and high intensity on T2-weighted imaging. Endoscopic retrograde cholangio-pancreatography (ERCP) showed neither communication between the cystic lesion and the main pancreatic duct nor encasement of the main pancreatic duct. Endoscopic ultrasonography revealed neither solid component nor thickness of the s...
Mucinous cystic neoplasm of the pancreas: a case report
Chirurgia italiana
Cystic neoplasms of the pancreas account for only a small percentage of pancreatic tumours. They include mucinous cystic tumours, which have a higher incidence in females in their forties or fifties. Cystic neoplasms of the pancreas can present in a benign, borderline or malignant form. These tumours have a natural evolution from a benign (mucinous cystadenoma) to a malignant form (cystadenocarcinoma). It is not always easy to diagnose cystic tumours, including mucinous cystic tumours of the pancreas, and the final diagnosis is often reached only after the surgical procedure, which is the gold standard treatment of this disease. We present the case of a 56-year-old woman affected by a mucinous cystic tumour of the body-tail of the pancreas, who underwent distal splenopancreasectomy. She was discharged on postoperative day 12. After an 18-month followup, she is in good general condition and disease-free.
International Journal of Surgery Case Reports, 2019
INTRODUCTION: Mucinous cystic neoplasms (MCN) are rare premalignant neoplasms of the pancreas that are typically found as single lesions in the pancreatic body and tail of women in the fifth and sixth decade of life, do not communicate with the pancreatic ductal system and are characterized by mucin-producing epithelium supported by ovarian-type stroma. PRESENTATION OF CASE: We present here a case of diffuse pancreatic involvement by MCN in a 64year-old woman with chronic pancreatitis. Pre-operative suspicion for MCN was low due to the multicentric nature of the lesions and imaging/biochemical fluid analysis demonstrating connection with the pancreatic ductal architecture. The patient underwent total pancreatectomy with pathology showing multiple cysts lined by flat epithelium with focal ovarian-type stroma, consistent with low-grade MCN. DISCUSSION: The presence of ovarian stroma on histological analysis is one of the defining characteristics of MCNs per WHO guidelines, and is mandatory for its diagnosis. Only one case of diffuse MCN has been previously described in the literature; however, in this case the authors were not able to reach a definitive histological diagnosis based on WHO criteria. CONCLUSION: To our knowledge, this is the first report of diffuse histology-proven MCN of the pancreas.
Mucinous Cystic Neoplasms of Pancreas
Gastroenterology Research, 2014
Elmer This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited
Lietuvos chirurgija
Background. Pancreatic mucinous cystic neoplasm (PMCN) with associated invasive carcinoma is a rare entity. According to the World Health Organisation (WHO) 2010, PMCN with associated invasive carcinoma is referred to the malignant lesions of the pancreatic epithelial tumour. Case report. A 52-year-old female patient presented with pain in the umbilical and epigastric regions for 5 months and noticed a solid visible tumour on the left side of the abdomen 3 months ago when she lied down. The level of the CA125 was 47.64 U/ml (normal value <35 U/ml). Abdominal and pelvic magnetic resonance imaging (MRI) showed a cystic multiseptal mass in the left iliac region, defined as a left ovary tumour, while Computed tomography scan revealed a cystic tumour of the pancreatic tail. The patient underwent a resection of the pancreatic tail with a 20 cm cystic solid tumour, splenectomy and left hemicolectomy. Histopathology report confirmed mucinous cystic neoplasm of the pancreatic tail with as...
Cystic Tumors Of Pancreas: Diagnostic And Therapeutic Strategy
The Internet Journal of Surgery, 2014
Cystic tumors of the pancreas arise problems preoperative diagnosis. Now this is the diagnostic certainty that determines surgical indications. Aim: To report our support diagnosis and treatment of these tumors. Patients and methods: it is a retrospective study of six patients with a mean age of 32 years with extremes of 22 and 61 years. The parameters studied were the diagnostic and therapeutic data. Results: The reason for consultation was a mass of epigastric or left upper quadrant in 3 cases and abdominal pain in 3 cases. The tumor marker Ca19.9 was normal in 2 cases and the ACE marker slightly elevated in 1 case. The scanner evoked a cystic mass in the tail of the pancreas in 5 cases and magnetic resonance imaging (MRI) intrapapillary mucinous tumor of the pancreas probably degenerate of the pancreas’s head in 1 case. Preoperative presumptive diagnosis was mucinous cystadenoma in 3 cases, a solid pseudopapillary tumor in 1 case, an degenerated in 1 case and a false cyst of the ...
Mucinous cystic neoplasm of pancreas a case report
International Surgery Journal
Mucinous cystic neoplasm of pancreas are relatively rare >95% occur in the body and tail of pancreas. Majority occur in young and middle aged female containing ovarian type subepithelial stroma. These tumors are either premalignant (MCN with low grade dysplasia) or (MCN with high grade dysplasia) or invasive carcinoma. Differential diagnosis includes pancreatic pseudocyst and pancreatic hydatid cyst. Investigations include ultrasonography (USG), Magnetic resonance imaging (MRI), Contrast enhanced computed tomography (CECT) supplemented by endoscopic USG with cyst fluid aspiration.