Pancreatic mucinous cystic neoplasm

Pancreatic mucinous cystic neoplasm (MCN) is a type of cystic lesion that occurs in the pancreas. Amongst individuals undergoing surgical resection of a pancreatic cyst, about 23 percent were mucinous cystic neoplasms. These lesions are benign, though there is a high rate of progression to cancer. As such, surgery should be pursued when feasible. The rate of malignancy present in MCN is between 11 and 38 percent. If resection is performed before invasive malignancy develops, prognosis is excellent. The extent of invasion is the single most important prognostic factor in predicting survival.[1]

Pancreatic mucinous cystic neoplasm
Other namesMCN
SpecialtyGastroenterology

Pathology

Factors that predict malignancy include loculated appearance, mural nodules, papillary projections, p53 immunoreactivity, and loss of ovarian-like stroma.[1]

Management

Where possible, surgical resection of mucinous cystic neoplasms is preferable. In individuals unable to undergo surgery, there may be a role for endoscopic ultrasound (EUS) guided ablation with alcohol lavage with paclitaxel injection. EUS guided therapy has been performed successfully, though more data is necessary, particularly prospective study.[2][3] An EUS-guided approach appears more effective with smaller sized MCNs.[4]

Epidemiology

MCNs are much more common in women.[5] A study in 2012 found that amongst individuals undergoing surgical resection of a pancreatic cyst, about 23 percent were mucinous cystic neoplasms.[6] The rate of malignancy present in MCN is between 11 and 38 percent. Malignancy is more often present in older individuals.[7]

See also

References
  1. Zamboni, G; Scarpa, A; Bogina, G; Iacono, C; Bassi, C; Talamini, G; Sessa, F; Capella, C; Solcia, E; Rickaert, F; Mariuzzi, GM; Klöppel, G (April 1999). "Mucinous cystic tumors of the pancreas: clinicopathological features, prognosis, and relationship to other mucinous cystic tumors". The American Journal of Surgical Pathology. 23 (4): 410–22. doi:10.1097/00000478-199904000-00005. PMID 10199470.
  2. Gan, SI; Thompson, CC; Lauwers, GY; Bounds, BC; Brugge, WR (May 2005). "Ethanol lavage of pancreatic cystic lesions: initial pilot study". Gastrointestinal Endoscopy. 61 (6): 746–52. doi:10.1016/s0016-5107(05)00320-2. PMID 15855986.
  3. Oh, HC; Seo, DW; Lee, TY; Kim, JY; Lee, SS; Lee, SK; Kim, MH (April 2008). "New treatment for cystic tumors of the pancreas: EUS-guided ethanol lavage with paclitaxel injection". Gastrointestinal Endoscopy. 67 (4): 636–42. doi:10.1016/j.gie.2007.09.038. PMID 18262182.
  4. Oh, HC; Seo, DW; Song, TJ; Moon, SH; Park, DH; Soo Lee, S; Lee, SK; Kim, MH; Kim, J (January 2011). "Endoscopic ultrasonography-guided ethanol lavage with paclitaxel injection treats patients with pancreatic cysts". Gastroenterology. 140 (1): 172–9. doi:10.1053/j.gastro.2010.10.001. PMID 20950614.
  5. Reddy, RP; Smyrk, TC; Zapiach, M; Levy, MJ; Pearson, RK; Clain, JE; Farnell, MB; Sarr, MG; Chari, ST (November 2004). "Pancreatic mucinous cystic neoplasm defined by ovarian stroma: demographics, clinical features, and prevalence of cancer". Clinical Gastroenterology and Hepatology. 2 (11): 1026–31. doi:10.1016/s1542-3565(04)00450-1. PMID 15551256.
  6. Valsangkar, NP; Morales-Oyarvide, V; Thayer, SP; Ferrone, CR; Wargo, JA; Warshaw, AL; Fernández-del Castillo, C (September 2012). "851 resected cystic tumors of the pancreas: a 33-year experience at the Massachusetts General Hospital". Surgery. 152 (3 Suppl 1): S4-12. doi:10.1016/j.surg.2012.05.033. PMC 3806101. PMID 22770958.
  7. Crippa, Stefano; Salvia, Roberto; Warshaw, Andrew L.; Domínguez, Ismael; Bassi, Claudio; Falconi, Massimo; Thayer, Sarah P.; Zamboni, Giuseppe; Lauwers, Gregory Y.; Mino-Kenudson, Mari; Capelli, Paola; Pederzoli, Paolo; Castillo, Carlos Fernández-del (April 2008). "Mucinous Cystic Neoplasm of the Pancreas is Not an Aggressive Entity". Annals of Surgery. 247 (4): 571–579. doi:10.1097/SLA.0b013e31811f4449. PMC 3806104. PMID 18362619.
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