PURPOSE: The aim of this study is to determine possibility of application of in vivo proton (1H) magnetic resonance spectroscopy (MRS) in distinguishing cystic mass arising around pancreas by comparison of in vivo MRS, in vitro MRS using 3T MR machine, based on nuclear magnetic resonance (NMR). MATERIALS AND METHODS: We obtained spectra of in vivo MRS, in vitro MRS and NMR from abdominal mass arising around pancreas (mucinous cystic neoplasm=5, intraductal papillary mucin producing tumor=5, pseudocyst=1, and lymphangioma=1). We estimated existence of peak of in vivo MRS, and in vitro MRS concordant to that of NMR. We also evaluated differential peak for predicting specific disease. RESULTS: Correlation of presence of peak with NMR showed showed sensitivity of 29.6%, specificity of 82.6% and accuracy of 67.7% on in vivo MRS (p = 0.096, McNemar test), sensitivity of 57.1% and specificity of 92.6% and accuracy of 82.3% on in vitro MRS (p = 0.362, McNemar test). The spectra of NMR for IPMT showed more frequent peaks at 3.5-4.0 ppm (p=0.026). CONCLUSION: Although chemical analysis, using NMR could be regarded as possible tool to differentiate cystic masses, in vivo and in vitro MRS need further technical evolution for clinical application.
Magnetic Resonance Spectroscopy ; Mucins ; Pancreas ; Protons ; Sensitivity and Specificity ; Spectrum Analysis

PURPOSE: Branch duct type intraductal papillary mucinous neoplasms (Br-IPMN) have better prognosis and lower malignancy rate than do main duct type IPMNs (M-IPMN). However, surgical resection is necessary when malignancy is suspected, and radical resection should be performed in cases of invasive IPMN. The objectives of this study were to investigate the characteristics of Br-IPMN and related predictive malignancy/invasiveness factors and to present a standardized scoring system for predicting pathologic results. METHODS: We conducted a retrospective review of 91 patients diagnosed with Br-IPMNs between 1998 and 2007. Mean patient age was 62.5+/-9.0 years. Eighty (87.9%) patients had benign IPMNs (17 adenoma, 63 borderline malignancy), and 11 (12.1%) patients had malignant IPMNs (4 carcinoma in situ, 7 invasive carcinoma). Eighty-four (92.3%) patients had noninvasive IPMN, and 7 (7.7%) patients had invasive IPMN. RESULTS: The size of the cystic mass and the presence and size of the mural nodule were found by univariate analysis to be significantly different between the benign and malignant groups. History of DM, size of the cystic mass, size of the mural nodule, and thickness of the cystic wall were significantly different between the noninvasive and invasive IPMN groups on univariate analysis. The regression coefficients for the size of the cystic mass and for the size and presence of the mural nodule were calculated using multivariate analysis, and the scores predicting malignant and invasive IPMN determined (P=0.001, P=0.000, respectively). CONCLUSION: There are no universally held guidelines for surgical management of Br-IPMN patients. Hence, many clinicians have difficulty deciding the specific character of the resection they will pursue. By using malignancy- and invasiveness-predicting scores, we expect that much of this difficulty can be avoided in the future.
Adenoma ; Carcinoma in Situ ; Humans ; Mucins ; Multivariate Analysis ; Pancreas ; Prognosis ; Retrospective Studies

BACKGROUNDS/AIMS: International treatment guidelines for branch duct intraductal papillary mucinous neoplasm (BD-IPMN) of the pancreas have been proposed, for features associated with malignancy and invasiveness. We investigated the clinicopathological characteristics that are predictive of malignancy or invasiveness and disease recurrence. METHODS: A review of 324 patients with resected and pathologically confirmed BD-IPMN, between March 1997 and December 2013, was conducted. RESULTS: There were 144 (44.4%) low grade dysplasia (LGD), 138 (42.6%) intermediate grade dysplasia (IMGD), 17 (5.3%) high grade dysplasia (HGD), and 25 (7.7%) invasive carcinoma (invIPMC) cases. The 5-year survival rates were 98.1% for LGD, 95.3% for IMGD, 100% for HGD, and 71.8% for invIPMC. Through a univariate analysis, the male sex was associated with malignancy, and CA19-9 was related to both malignant and invasive IPMN. The high risk or worrisome features of the international guidelines were associated with both malignant and invasive IPMN: the total bilirubin of the head/uncinate lesion, tumor size, mural nodule, and the size of the main pancreatic duct (MPD). Through a multivariate analysis, the male sex, elevated CA19-9, mural nodule, and dilated MPD diameter were independently correlated with the malignant IPMN. The elevated CA19-9 and dilated MPD diameter were also correlated with invasive carcinoma. The patient age and the initial pathological diagnosis were strongly associated with disease recurrence following surgical resection. CONCLUSIONS: The high risk or worrisome features in the current treatment guidelines for BD-IPMN are confined to the morphological characteristics of the disease. Patient factors and biological features should also be considered in order to develop optimal therapeutic or surveillance strategies.
Bilirubin ; Diagnosis ; Humans ; Male ; Mucins* ; Multivariate Analysis ; Pancreas* ; Pancreatic Ducts ; Recurrence ; Survival Rate

BACKGROUND: Gastric carcinomas (GCs) have recently been reclassified according to the mucin phenotypes. We aimed to characterize the relationship between the mucin phenotypes and the genetic alterations or the clinicopathologic parameters of GCs. METHODS: Immunohistochemistry was performed for MUC1, MUC5AC, MUC6, MUC2, CD10, p53, hMLH1, CerbB2 and E-cadherin in 150 GCs. The mucin phenotypes of the GCs were classified as 4 phenotypes: gastric, intestinal, mixed and unclassified. RESULTS: MUC1, MUC5AC, MUC6, MUC2 and CD10 were expressed in 63.3%, 42.7%, 14.0%, 24.7% and 14.0% of the GCs, respectively. The mucin phenotypes of the GCs corresponded to the gastric type in 31.3%, the intestinal type in 20.0%, the mixed type in 15.3% and the unclassified type in 33.3%. The incidence of a p53 overexpression was higher in the gastric or mixed phenotype than in the intestinal or unclassified phenotype. MUC5AC expression, p53 overexpression and the gastric or mixed phenotype were associated with poor patient survival by multivariate analysis. CONCLUSION: This study suggests the gastric or mixed mucin phenotype may more likely go through the p53 pathway in carcinogenesis and the mucin phenotype may be considered as a prognostic indicator.
Cadherins ; Carcinogenesis ; Humans ; Immunohistochemistry ; Incidence ; Mucins* ; Multivariate Analysis ; Phenotype* ; Stomach ; Tumor Suppressor Protein p53

OBJECTIVE: It is still unclear whether angiogenic potential, which is believed to be a prerequisite for tumor development, is an important prognostic factor in ovarian carcinoma. The current study was designed to examine the relationship among Vascular endothelial growth factor (VEGF) expression, angiogenesis in ovarian neoplasms and clinicopathological prognostic variables. METHODS: A according to the WHO classification and FIGO staging epithelial ovarian carcinoma was classified. Microvessel density and VEGF status were evaluated by immunohistochemistry in 77 epithelial ovarian carcinomas. RESULTS: Positive immunostaining for VEGF was observed in 92.6% (50 out of 54) of ovarian carcinomas, which was significantly higher than that of low malignant potential (LMP) tumors (12 out of 23; 52.2%) (p<0.001). In ovarian carcinomas, positive VEGF immunostaining was also observed more frequently, even though not significantly, in tumor of elder age group (more than 60 years) (p=0.05) and less differentiated (p=0.05). CD34 immunostaining revealed increased microvessel density in ovarian carcinomas larger than 10 cm in size (p=0.029) and in mucinous type tumors (p=0.025). Microvessel counts of epithelial ovarian carcinomas examined were not correlated with VEGF expression. Histologic type (p=0.0428), differentiation (p=0.0083) and FIGO stage (p=0.0004) also influenced overall survival of ovarian carcinomas in univariate analysis. But multivariate analysis revealed that disease stage was the only significant and independent prognostic factor of ovarian carcinomas (p=0.001). In advanced ovarian tumors (stage III/IV), microvessel density was the only significant prognostic factor (p=0.002). CONCLUSION: Therefore, the expression of VEGF could be used as an adjuvant indicator of differing borderline tumor from ovarian carcinoma. And microvessel density of advanced ovarian carcinoma may enhance the predictability of patient at high risk for tumor progression who are potential candidate for further aggressive therapy.
Classification ; Humans ; Immunohistochemistry ; Microvessels* ; Mucins ; Multivariate Analysis ; Ovarian Neoplasms ; Prognosis* ; Vascular Endothelial Growth Factor A*

PURPOSE: Mucinous gastric carcinoma (MGC) is a histopathologic subtype of gastric adenocarcinoma with a poor prognosis. It comprises about 3~10% of gastric carcinomas. The purpose of this study was to compare the disease course of MGC with non-MGC (NMGC) and study the clinicopathologic features that influence the prognosis of MGC patients. METHODS: We reviewed the records of 2,383 patients with a confirmed histologic diagnosis of gastric carcinoma who underwent surgery at the Department of Surgery, Chonnam National University Hospital. There were 157 patients with MGC compared to 2,226 with NMGC. Patients were evaluated on the basis of gender, age, tumor size, tumor location, depth of invasion, region and number of lymph nodes with metastasis, hepatic or peritoneal metastasis, stage at presentation, estimate of surgical curability, and TNM stage based on the UICC classification. Multivariate analysis was performed to test the hypothesis that the histologic mucin contents themselves in MGC are an independent prognostic factor. RESULTS: There was no gender or age-at-diagnosis distinction between these two groups. The mean tumor size of MGC was larger than that of NMGC, but the difference was not statistically significant. Most carcinomas of both types were located in the antrum with no statistical difference in location between MGC and NMGC. However, a depth of invasion greater than T3 was more frequently found in MGC than in NMGC, not to a statistically significant degree. The mean number of lymph node with metastases was 2.78 in MGC and 2.28 in NMGC (P<0.001). There were more MGC patients with TNM stages II through IV(UICC classification). The overall survival rate was lower for the MGC group(46.5%) than for the NMGC group (64.0%). Depth of invasion, lymph node metastasis, and stage at diagnosis were significant factors affecting the outcome. Mucinous histologic type itself was not an independent predictive factor in survival. CONCLUSION: The factors that influence the poorer prognosis(lower 5-year survival rate) of MGC are advanced stage at the time of diagnosis, lymph node metastases, and a higher TNM status. The histologic subtype itself was not an independent prognostic factor.
Adenocarcinoma ; Classification ; Diagnosis ; Humans ; Jeollanam-do ; Lymph Nodes ; Mucins* ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis* ; Survival Rate

PURPOSE: Mucinous cells (MUCs), signet-ring cells (SRCs), and poorly differentiated cells (PDCs) are uncommon histologic types and have been associated with advanced tumor stage and poor prognosis. However, MUCs, SRCs, and PDCs are commonly observed in cancers with high microsatellite instability (MSI), which have favorable outcomes compared with cancers with microsatellite stability (MSS). The purpose of this study was to evaluate the prognostic impact of high-MSI in patients with sporadic colorectal cancer presenting with MUCs, SRCs, and/or PDCs. METHODS: Between January 2006 and December 2012, 176 with proven microsatellite status who also presented with MUCs, SRCs, and PDCs were selected for this study and were divided into 2 groups, high-MSI and MSS; their outcomes were analyzed. RESULTS: Of the 176 patients, 56 and 120, respectively, had high-MSI and MSS cancers. High-MSI cancers had larger tumors, proximal tumor location, and a lower TNM stage. The recurrence rate was lower in the high-MSI group (13.7% vs. 35.4%, P = 0.006). Common patterns of distant metastasis for MUC, SRC, PDC cancers were peritoneal spread (46.9%) and hematogenous metastasis (46.4%). The 5-year CSS rates were 88.2% and 61.2% for patients with high-MSI and MSS cancers, respectively (P < 0.0001). In the multivariate analysis, except for stage-IV cancer, MSI status was an independent risk factor for cancer-specific survival (MSS: hazard ratio, 4.34; 95% confidence interval, 1.68-11.21). CONCLUSION: In patients with colorectal cancer presenting with MUCs, SRCs, and/or PDCs, those with high-MSI cancers had better outcomes.
Colorectal Neoplasms* ; Humans ; Microsatellite Instability* ; Microsatellite Repeats* ; Mucins* ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Risk Factors

OBJECTIVE: The purpose of this study was to clarify the clinical features of epithelial ovarian carcinoma (EOC) in younger vs. older patients in Japan. METHODS: We collected data on 1,562 patients with EOC treated at multiple institutions in the Tokai Ovarian Tumor Study Group, and analyzed them retrospectively. All patients were divided into 2 groups: group A (< or =40 years old) and group B (>40 years old). The data were analyzed to evaluate prognostic factors and the distribution of features in each group. Patients were subjected to univariate and multivariate analyses to evaluate overall survival (OS). RESULTS: The median follow-up time was 45.1 months (range, 1 to 257 months). Patients in group A had a significantly higher rate of stage I disease (67.3% vs. 42.6%, respectively; p<0.001) and the mucinous type (36.7% vs. 13.5%, respectively; p<0.001) than those in group B. There was a significant difference of OS between the 2 groups (p=0.013). However, upon stratification according to the stage, there were no significant differences in the OS between the 2 groups (group A vs. B: stage I, p=0.533; stage II-IV, p=0.407). Multivariate analysis revealed that younger age was not an independent prognostic factor for OS. CONCLUSION: On the basis of our data, younger patients had a different clinical profile than older patients, particularly regarding the stage of the disease and pathological distribution; however, they showed a similar long-term prognosis, even upon stratification according to the stage.
Asian Continental Ancestry Group* ; Female ; Follow-Up Studies ; Humans ; Japan ; Mucins ; Multivariate Analysis ; Prognosis ; Retrospective Studies

BACKGROUND: We reviewed a series of 188 resected pulmonary mucinous adenocarcinomas (MAs) to clarify the prognostic significance of lepidic and non-lepidic patterns. METHODS: Non-lepidic patterns were divided into bland, non-distorted acini with uncertain invasiveness (pattern 1), unequivocal invasion into stroma (pattern 2), or invasion into alveolar spaces (pattern 3). RESULTS: The mean proportion of invasive patterns (patterns 2 and 3) was lowest in small (≤ 3 cm) tumors, and gradually increased in intermediate (> 3 cm and ≤ 7 cm) and large (> 7 cm) tumors (8.4%, 34.3%, and 50.1%, respectively). Adjusted T (aT) stage, as determined by the size of invasive patterns, was positively correlated with adverse histologic and clinical features including older age, male sex, and ever smokers. aTis tumors, which were exclusively composed of lepidic pattern (n = 9), or a mixture of lepidic and pattern 1 (n = 40) without any invasive patterns, showed 100% disease- free survival (DFS). The aT1mi tumors, with minimal (≤ 5 mm) invasive patterns (n = 63), showed a 95.2% 5-year DFS, with recurrences (n = 2) limited to tumors greater than 3 cm in total size (n = 23). Both T and aT stage were significantly associated with DFS; however, survival within the separate T-stage subgroups was stratified according to the aT stage, most notably in the intermediatestage subgroups. In multivariate analysis, the size of invasive patterns (p = .020), pleural invasion (p < .001), and vascular invasion (p = .048) were independent predictors of recurrence, whereas total size failed to achieve statistical significance (p = .121). CONCLUSIONS: This study provides a rationale for histologic risk stratification in pulmonary MA based on the extent of invasive growth patterns with refined criteria for invasion.
Adenocarcinoma in Situ ; Adenocarcinoma, Mucinous* ; Disease-Free Survival ; Humans ; Lung ; Male ; Mucins* ; Multivariate Analysis ; Recurrence*

PURPOSE: The aim of this study was to evaluate the value of mucinous histology as a predictive marker of 5-Fluorouracil (FU)-based adjuvant chemotherapy in stage II, III colon cancer. METHODS: Between January 1995 and December 2004, 987 patients who underwent curative resections for stage II, III sporadic colon cancer were classified into two groups, a mucinous carcinoma (MC) group and a non-mucinous carcinoma (NMC) group, based on the histology of the primary tumor. The differences in their clinicopathological characteristics and the prognostic impact of 5-FU-based adjuvant chemotherapy for various tumor histologies were analyzed. RESULTS: Of the 987 patients, MCs accounted for 6.8% (68 patients). MCs were more frequently located in the Rt. Colon (P<0.001) and were more frequently seen in young patients (less than 40 yr old) (P=0.028). The 5-yr survival rates between MC and NMC did not show any statistically significant difference. Patients, including both MC and NMC patients, who received 5-FU-based chemotherapy, revealed a better overall survival rate than patients with no adjuvant chemotherapy. In the multivariate analysis for the prognosis in NMC patients, 5-FU-based adjuvant chemotherapy, initial negative nodal status, and preoperative CEA <5 ng/mL were statistically significant prognostic factors (P values: <0.001, <0.001, and <0.001, respectively). In contrast, there was no statistically independent significance of 5-FU-based adjuvant chemotherapy in MC patients. CONCLUSION: In stage II and stage III sporadic colon cancer patients, response to 5-FU-based adjuvant chemotherapy in MC patients might be poor than it is in NMC patients.
Adenocarcinoma, Mucinous ; Chemotherapy, Adjuvant ; Colon ; Colonic Neoplasms ; Fluorouracil ; Humans ; Mucins ; Multivariate Analysis ; Prognosis ; Survival Rate