BACKGROUND/AIMS: Intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms are included in mucin-producing pancreatic tumors. The reports about IPMN are not uncommon but those about the mucinous cystic neoplasms are relatively few. The aims of this study were to define the natural history of resected mucinous cystic neoplasms of the pancreas and to identify the findings which suggest malignancy. METHODS: The authors retrospectively evaluated the clinical outcomes of 41 patients with mucinous cystic neoplasms who were surgically resected at Asan Medical Center between 1995 and 2004. RESULTS: Women (n=33) were more frequently affected than men (n=8). Thirty three patients (80.6%) had adenoma, 1 (2.4%) borderline malignancy, 1 (2.4%) carcinoma in situ, and 6 (14.6%) invasive mucinous cystadenocarcinoma. The most frequent symptom was abdominal pain (39%). About half of the enrolled patients were asymptomatic. Unilocular type (79%) was more frequent than the multilocular type (21%) on gross morphology. The tumor size of invasive mucinous cystic neopolasms was larger than that of non-invasive mucinous cystic neoplalsms (p=0.01). Abdominal pain was more frequent in invasive mucinous cystic neoplasms (p=0.026). On gross morphology, mural nodules were detected in 4 of 6 patients with invasive mucinous cystic neoplasms. However, they were not detected in any patients with non-invasive mucinous cystic neoplasms. Recurrence developed in none of the 35 patients with non-invasive mucinous cystic neoplasms, however 2 of the 6 patients with invasive mucinous cystic neoplasms died within 5 years. CONCLUSIONS: Clinical predictors of invasive mucinous cystic neoplasms are suggested to be tumor size and abdominal pain. The prognosis of the non-invasive mucinous cystic neoplasms is excellent when curative resection is performed.
Adenocarcinoma, Mucinous/*diagnosis/pathology/surgery ; Adult ; Aged ; Carcinoma, Pancreatic Ductal/diagnosis/pathology/surgery ; Cystadenocarcinoma, Mucinous/diagnosis/pathology ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Invasiveness ; Pancreatic Neoplasms/*diagnosis/pathology/surgery ; Retrospective Studies ; Survival Analysis

Adenocarcinoma ; diagnosis ; pathology ; surgery ; Adenocarcinoma, Mucinous ; diagnosis ; pathology ; surgery ; Adult ; Aged ; Carcinoma, Squamous Cell ; diagnosis ; pathology ; surgery ; Cholecystectomy ; methods ; Female ; Follow-Up Studies ; Gallbladder Neoplasms ; diagnosis ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Retrospective Studies ; Survival Rate

Adenocarcinoma, Mucinous ; pathology ; Aged ; Appendectomy ; methods ; Appendiceal Neoplasms ; pathology ; surgery ; Appendicitis ; pathology ; Appendix ; pathology ; Carcinoid Tumor ; pathology ; surgery ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Male

No abstract available.
Adenocarcinoma, Mucinous/diagnosis/pathology ; Adenocarcinoma, Papillary/diagnosis/pathology ; Carcinoma, Pancreatic Ductal/*diagnosis/pathology/surgery ; Diagnosis, Differential ; Humans ; Male ; Middle Aged ; Mucin-1/analysis ; Pancreatic Neoplasms/*diagnosis/pathology/surgery ; Tomography, X-Ray Computed

Compared with other types of cancers, pancreatic cancer is one of the most dreadful malignancies and is fifth leading cause of cancer-related death in Korea. It is difficult to expect early diagnosis or improvement in prognosis due to lack of specific early symptoms and effective diagnostic methods. Whereas cystic neoplasm of the pancreas is a rare type of pancreatic tumor, surgical resection provides good prognosis because of its low possibility of local invasion or distant metastasis. In case of pancreatic cystic tumor, radiologic differentiation between benign and malignant lesions is crucial for the selection of appropriate treatment and the prediction of prognosis. And ductal adenocarcinoma of pancreas presenting in cystic form is an uncommon type of cystic tumor, making it extremely rare among all pancreatic malignancies. We report two cases of atypical pancreatic ductal adenocarcinoma presenting as solid pseudopapillary tumor and intraductal papillary mucinous neoplasm, respectively.
Adenocarcinoma, Mucinous/*diagnosis/surgery ; Adenocarcinoma, Papillary/*diagnosis/surgery ; Adult ; Carcinoma, Pancreatic Ductal/*diagnosis/pathology/surgery ; Female ; Humans ; Male ; Middle Aged ; Pancreatectomy ; Pancreatic Neoplasms/*diagnosis/pathology/surgery ; Tomography, X-Ray Computed

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a unique disease entity that is characterized by predominant intraductal growth of mucinous cells, copious mucin production, and subsequent cystic dilatation of pancreatic ducts. IPMN shows a spectrum of histologic and imaging findings and possesses as the potential for malignant transformation arising from adenoma to invasive carcinoma. It is important to determine the type, extent of duct involvement, and presence of malignant transformation, and to assess tumor grading prior to surgical resection. Thus, it would be helpful for physicians managing patients with IPMN of the pancreas to have a guideline for the diagnosis and treatment of IPMN. In this review, a role of radiological evaluation for diagnosis and preoperative assessment is described as well as presentation of the guideline for patient management.
Adenocarcinoma, Mucinous/*diagnosis/pathology/surgery ; Carcinoma, Pancreatic Ductal/*diagnosis/pathology/surgery ; Carcinoma, Papillary/*diagnosis/pathology/surgery ; Diagnosis, Differential ; Humans ; Magnetic Resonance Imaging ; Pancreatic Neoplasms/*diagnosis/pathology/surgery ; Preoperative Care ; Prognosis ; Tomography, X-Ray Computed

With increasing indence and peculiar clinico-pathological features, intraductal papillary mucinous neoplasm (IPMN) of the pancreas has been a major interest in the field of pancreatology. Although pathologic and clinical diversities make difficulty in decision of treatment of IPMN in some circumstances, surgical treatment is generally indicated for main duct IPMN and branch duct IPMN with suspected malignancy (tumor size >or=30 mm, mural nodules, dilated main pancreatic duct, or positive cytology) or prominent symptoms. IPMN has a favorable prognosis after the resection. However, invasive IPMN shows poor prognosis comparable to stage-matched pancreatic ductal adenocarcinoma. Conventional pancreatic resection is recommended in case of highly suspected malignant cases, and organ preserving pancreatectomy or minimal invasive surgery could be used, especially in benign looking branch duct IPMN. Before the surgical resection, clinician should consider patient's general and social condition as well as risk of malignancy to select proper type and extent of surgery.
Adenocarcinoma, Mucinous/diagnosis/pathology/*surgery ; Carcinoma, Pancreatic Ductal/diagnosis/pathology/*surgery ; Carcinoma, Papillary/diagnosis/pathology/*surgery ; Humans ; *Pancreatectomy ; Pancreatic Neoplasms/diagnosis/pathology/*surgery ; Preoperative Care ; Survival Analysis ; Treatment Outcome

Multiple primary malignancy was reported firstly by Billroth in 1889. Recently, multiple primary malignancies are considered to increase due to improved survival rate of cancer patients, advanced diagnostic tools, and increased use of chemotherapy and radiotherapy. In Korea, several cases of triple primary malignancies were reported. However, four primary malignancies in gastro-intestinal tract was rarely reported. Recently, we experienced a 70 year-old male who was diagnosed with metachronous four primary malignancies in rectum, ascending colon, stomach, and ampulla of Vater. We report this rare case of metachronous four primary malignancies with a review of literature.
Adenocarcinoma/*diagnosis/pathology/surgery ; Adenocarcinoma, Mucinous/diagnosis/surgery ; Aged ; Ampulla of Vater/*pathology ; Colonic Neoplasms/diagnosis/surgery ; Common Bile Duct Neoplasms/*diagnosis/pathology/surgery ; Gastrointestinal Neoplasms/*diagnosis/pathology/radiography ; Humans ; Male ; Neoplasms, Second Primary/*diagnosis/pathology ; Rectal Neoplasms/diagnosis/surgery ; Stomach Neoplasms/diagnosis/pathology/surgery ; Tomography, X-Ray Computed

Adenocarcinoma, Mucinous ; pathology ; Adult ; Breast Neoplasms ; metabolism ; pathology ; surgery ; Carcinoma ; pathology ; Carcinoma in Situ ; metabolism ; pathology ; surgery ; Carcinoma, Ductal, Breast ; metabolism ; pathology ; surgery ; Diagnosis, Differential ; Female ; Fibrocystic Breast Disease ; metabolism ; pathology ; surgery ; Humans ; Hyperplasia ; Lactalbumin ; metabolism ; S100 Proteins ; metabolism

Adenocarcinoma, Mucinous ; metabolism ; pathology ; surgery ; Carcinoid Tumor ; metabolism ; pathology ; surgery ; Chromogranin A ; metabolism ; Diagnosis, Differential ; Gastrectomy ; methods ; Gastrointestinal Stromal Tumors ; pathology ; Humans ; Male ; Middle Aged ; Neoplasms, Multiple Primary ; metabolism ; pathology ; surgery ; Stomach Neoplasms ; metabolism ; pathology ; surgery ; Synaptophysin ; metabolism