Cystic tumors of the pancreas – our experience with diagnostics

Česká verzia

Authors: T. Krechler ¹; J. Ulrych ²; M. Dvořák ¹; D. Hoskovec ²; J. Macášek ¹; T. Švestka ¹; J. Hořejš ³
Authors place of work: IV. interní klinika – klinika gastroenterologie a hepatologie 1. lékařské fakulty UK a VFN Praha, přednosta prof. MU Dr. Aleš Žák, DrSc. ¹; I. chirurgická klinika – břišní, hrudní a úrazové chirurgie 1. lékařské fakulty UK a VFN Praha, přednosta prof. MU Dr. Zdeněk Krška, CSc. ²; Radiodiagnostická klinika 1. lékařské fakulty UK a VFN Praha, přednosta prof. MU Dr. Jan Daneš, CSc. ³
Published in the journal: Vnitř Lék 2013; 59(7): 572-577
Category:

Summary

Number of newly diagnosed cystic pancreatic tumors is permanently increasing. This fact is primarily related to the development of new diagnostic methods. The main representative ones are: serous cystadenoma, mucinous cystic neoplasm, intraductal papillary mucinous neoplasm and solid pseudopapillar tumor. Because of the malignant potential of these lesions, proper indication of surgical treatment is extremely important. The article highlights and describes our experience in diagnostics and therapy of cystic pancreatic tumors diagnosed in the General Teaching Hospital Prague in the period: 1/ 2008– 12/ 2012. All patients were investigated by computerised tomography and endoscopic ultrasound with fine – needle aspiration biopsy. Thirty seven patients in total were diagnosed with cystic pancreatic tumors: 19 with serous cystadenoma, 5 with mucinous cystic neoplasm, 5 with mucinous cystadenocarcinoma, 5 with intraductal papillary mucinous neoplasm and 3 with solid pseudopapillar tumor. In 14 cases patients were indicated for surgery, in 1 case signs of malignant transformation were found. Determination of the optimal strategy for diagnostic and therapeutic procedures in patients with cystic pancreatic tumors requires the diagnosis, treatment and follow‑up observation in adequately equiped specialized centers.

Key words:
cystic pancreatic tumors – serous cystadenoma – mucinous cystic neoplasm – intraductal papillary mucinous neoplasm – solid pseudopapillary tumor – diagnostics – therapy – endoscopic ultrasound – fine‑ needle apiration biopsy

Zdroje

1. Singhal D, Kakodkar R, Sud R el al. Issues in the management of pancreatic pseudocysts. JOP 2006; 7: 502– 507.

2. Warshaw AL. Pancreatic cysts and pseudocysts: new rules for a new game. Br J Surg 1989; 76: 533– 534.

3. Yamaguchi T, Takahashi H, Kagawa R et al. Huge pseudocysts of the pancreas caused by poorly differential invasive ductal adenocarcinoma with osteoclas‑like cells: report of a case. Hepatogastroenterology 2007; 54: 599– 601.

4. Oehler U, Jürs M, Klöppel G et al. Osteoclast‑like giant cell tumour of the pancreas presenting as pseudocyst‑like lesion. Virchows Arch 1997; 431: 215– 218.

5. Jin YM, Yim H, Choi IJ et al. Pancreas serous cystadenoma mimicking pseudocyst. Yonsei Med J 1997; 38: 63– 65.

6. Myung SJ, Kim MN, Lee SK et al. Adenosquamous carcinoma of the pancreas: differentiation from pancreatic pseudocyst. Gastrointest Endosc 1998; 47: 410– 413.

7. Volkan Adsay N. Cystic lesions of the pancreas. Mod Pathol 2007; 20 (Suppl 1): S71– S93.

8. Strobbel O, Z’graggen K, Schmitz‑ Winnenthal FH et al. Risk of malignancy in serous cystic neoplasms of the pancreas. Digestion 2003; 68: 24– 33.

9. Tseng IF, Warshaw AL, Sahani DV et al. Serous cystadenoma of the pancreas: tumour growth rates and recommendations for treatment. Ann Surg 2005; 242: 413– 421.

10. Goh BK, Tan YM, Yap YM et al. Pancreas serous oligocystic adenomas: clinicopathologic features and a comparison with serous microcystic adenomas and mucinous cystic neoplasma. World J Surg 2006; 30: 1553– 1559.

11. Salvia R, Festa J, Butturini G et al. Pancreatic cystic tumours. Minerva Chir 2004; 59: 185– 207.

12. Campbell F, Azadeh B. Cystic neoplasms of the exocrine pancreas. Histopathology 2008; 52: 539– 551.

13. Tanaka M, Chari S, Adsay NV et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 2006; 6: 17– 32.

14. Singh M, Maitra A. Precursor lesions of pancreatic cancer: molecular pathology and clinical implications. Pancreatology 2007; 7: 9– 19.

15. Tanaka M. Intraductal papillary mucinous neoplasm of the pancreas: diagnosis and management. Pancreas 2004; 28: 282– 288.

16. Nagai K, Doi R, Kida A et al. Intraductal papillary mucinous neoplasms of the pancreas: clinicopathologic characteristic and long‑term follow‑up after resection. World J Surg 2008; 32: 271– 280.

17. Sohn TA, Yeo CI, Cameron JL et al. Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Ann Surg 2004; 239: 788– 799.

18. Shima Y, Mori M, Takakura N et al. Diagnosis and management of cystic pancreatic tumours with mucin production. Br J Surg 2000; 87: 1041– 1047.

19. Yamaguchi T, Ogawa Y, Chijiiwa K et al. Mucin‑hypersecreting tumours of the pancreas: assessing the grade of malignancy preoperatively. Am J Surg 1996; 171: 427– 431.

20. Traverso LW, Peralta EA, Ryan JA Jr et al. Intraductal neoplasms of the pancreas. Am J Surg 1998; 175: 426–432.

21. Sugiyama M, Atomi Y. Intraductal papillary mucinous tumours of the pancreas: imaging studies and treatment strategies. Ann Surg 1998; 228: 685– 691.

22. Matsumoto M, Aramaki M, Yada K et al. Optimal management of the branch duct type intraductal papillary mucinous tumours of the pancreas. J Clin Gastroenterol 2003; 36: 261– 265.

23. Sugiyama M, Izumisato Y, Abe N et al. Predictive factors for malignancy in intraductal papillary‑ mucinous tumours of the pancreas. Br J Surg 2003; 90: 1244– 1249.

24. Rodriguez IR, Salvia R, Crippa S et al. Branch‑ duct intraductal papillary mucinous neoplasms: observations in 145 patients who underwent resection. Gastroenterology 2007; 133: 72– 79.

25. Del Chiaro M, Verbeke C, Salvia R et al. European experts consensus statement on cystic tumours of the pancreas. Dig Liver Dis 2013. In press.

26. D’Angelica M, Brennan MF, Suriawanata AA et al. Intraductal papillary mucinous neoplasms of the pancreas: an analysis of clinicopathologic features and outcome. Ann Surg 2004; 239: 400– 408.

27. Michaels PJ, Brachtel EF, Bounds BC et al. Intraductal papillary mucinous neoplasm of the pancreas: cytologic features predict histologic grade. Cancer 2006; 108: 163– 173.

28. Garcea G, Ong SL, Rajesh A et al. Cystic lesions of the pancreas. A diagnostic and management dilemma. Pancreatology 2008; 8: 236– 251.

29. Tipton SG, Smyrk TC, Sarr MC et al. Malignant potential of solid pseudopapillary neoplasm of the pancreas. Br J Surg 2006; 93: 733– 737.

30. Roggin KK, Chennat J, Oto A et al. Pancreatic cystic neoplasm. Curr Probl Surg 2010; 47: 459– 510.

31. Adsay NV, Andea A, Weawer DC. Cen-trally necrotic invasive ductal adenocarcinomas of the pancreas presenting clinically as macrocystic leasions. Mod Pathol 2001; 13: 1125A.

32. Thompson NW, Eckhauser FE, Vinik AI et al. Cystic neuroendocrine neoplasms of the pancreas and liver. Ann Surg 1984; 199: 158– 164.

33. Repak R, Rejchrt S, Bartova J et al. Endoscopic ultrasonography (EUS) and EUS‑ guided fine‑ needle aspiration with cyst fluid analysis in pancreatic cystic neoplasms. Hepatogastroenterology 2009; 56: 629– 635.