OBJECTIVETo study the clinicopathologic and immunohistochemical features of cystic neoplasms of the pancreas.

METHODSNinety-two cases of cystic neoplasm of pancreas were retrieved from the Department archival file during the period from 1999 to 2005. Histologic features were studied and the tumors were typed according to WHO classification. Immunohistochemistry was also carried out using paraffin-embedded tissues.

RESULTSThe age of patients ranged from 16 to 80 years. The patients included 33 males and 59 females. The tumors varied from 2 cm to 21 cm in diameter. They consisted of intraductal papillary mucinous neoplasm (36/92), serous cystic neoplasm (18/92), solid pseudopapillary tumor (18/92), mucinous cystic neoplasm (14/92), cystic pancreatic ductal adenocarcinoma (4/92) and cystic pancreatic endocrine neoplasm (2/92). Immunohistochemical study revealed variable staining patterns, with frequent overlaps between different tumor types. In general, serous cystic neoplasm expressed MUC1, while mucinous cystic neoplasm was positive for MUC-5AC, intraductal papillary mucinous neoplasm for MUC-2 and cystic pancreatic ductal adenocarcinoma for MUC-1. On the other hand, solid pseudopapillary tumor expressed alpha-antitrypsin, alpha-antichymotrypsin, vimentin and progesterone receptor.

CONCLUSIONSAccurate diagnosis of pancreatic cystic neoplasms requires correlation of clinical findings, radiologic examination, histologic features and immunostaining results. Pathologic distinction is important because of different prognostic significance. Two-thirds of pancreatic cystic neoplasms are premalignant or malignant and warrant surgical resection, whereas the remaining one-third (including pseudocyst and serous cystadenoma) are benign and can be treated conservatively.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Papillary ; metabolism ; pathology ; Cystadenocarcinoma, Mucinous ; metabolism ; pathology ; Cystadenocarcinoma, Serous ; metabolism ; pathology ; Cystadenoma, Mucinous ; metabolism ; pathology ; Cystadenoma, Serous ; metabolism ; pathology ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Mucin 5AC ; metabolism ; Mucin-1 ; metabolism ; Neoplasms, Cystic, Mucinous, and Serous ; metabolism ; pathology ; Pancreatic Neoplasms ; metabolism ; pathology ; Young Adult

PURPOSE: To evaluate the usefulness of MRI findings in the differentiation of benign from malignant ovarian lesions. MATERIALS AND METHODS: Using MR findings, 29 surgically proven ovarian masses in 22 patients (14 bilateral tumors) were evaluated Twenty-one benign tumors in 16 patients (5 simple cysts, 4 mucinous cystadenomas, 4 serous cystadenomas, 4 endometriomas, 3 cystic teratomas and 1 tuboovarian abscess), and eight malignant tumors in six patients (4 serous papillary cystadenocarcinomas and 4 mucinous cystadenocarcinomas) were included. MRI was performed with SE T1WI, FSE T2WI and Gd-T1WI. MRI findings of lesion size, thickness of wall and of internal septations, number of internal septations, nodularities, and ancillary findings such as adhesion in the pelvic cavity, dissemination, ascites and lymphadenopathy were retrospectively analyzed. RESULTS: Malignant ovarian lesions were larger (18 cm : 11 cm) and had more internal septations, more solid components and nodularities (63 % : 5 %) than benign lesions. On T1WI, cystic lesions, both benign and malignant, showed low signal intensity. Hemorrhage, fat components and mucin containing lesions showed high signals and solid components and nodularities were isointense with muscle on T1WI. Solid components and nodularities were well-enhanced after gadolinium enhancement. Adhesion (50 % : 10 %), dissemination (38 % : 0 %) and ascites (63 % : 24 %) were more frequent in malignant lesions. CONCLUSION: MRI, especially with gadolinium-enhanced T1W1 is useful in the differentiation of benign from malignant ovarian lesions.
Ascites ; Cystadenocarcinoma, Papillary ; Cystadenoma, Mucinous ; Cystadenoma, Serous ; Endometriosis ; Female ; Gadolinium ; Hemorrhage ; Humans ; Lymphatic Diseases ; Magnetic Resonance Imaging* ; Mucins ; Retrospective Studies ; Teratoma

This study was performed to assess the significance of plasma level and histochemical character of carcinoembryonic antigen(CEA) in early diagnosis and prognosis of ovarian tumor. Plasma level of CEA was measured using EIA method and immunohistochemical tissue staining of CEA was done using biotin-strepto avidin complex immunoperoxidase technique. The percentage of patients with positive CEA level(above 2.5 ng/ml) was 23.1%(6/26) in malignant ovarian tumor and 15.6%(12/77) in benign ovarian tumor. Positive tissue staining of CEA was 42.3%(11/26) in malignant ovarian tumor and 19.5%(15/77) in benign ovarian tumor. In histologic typing, positive tissue staining of CEA was 18.1%(2/11) in serous cystadenocarcinoma, 85.7%(6/7) in mucinous cystadenocarcinoma, 37.5%(3/8) in other malignant ovarian tumors, 7.1%(1/15) in serous cystadenoma, 7.1%(1/14) in mucinous cystadenoma and 27.1%(13/48) in other benign ovarian tumors. Among 5 cases of malignant ovarian tumors with positive CEA level, 3 cases(60%) showed positive tissue staining of CEA, whereas among 21 cases of malignant ovarian tumors with negative CEA level, 8 cases (38.1%) showed positive tissue staining of CEA. However, among 11 cases of benign ovarian tumors with positive CEA level, 4 cases(36.4%) showed positive tissue staining of CEA, whereas among 66 cases of benign ovarian tumors with negative CEA level, 11 cases(16.7%) showed positive tissue staining of CEA. In the 3 year follow-up study of 12 cases with malignant ovarian tumor, among 3 cases with positive tissue staining of CEA, 2 cases(66.7%) survived. In 9 cases with negative tissue staining of CEA, 6 cases(66.7%) survived. In conclusion, these results suggest that the measurement of tumor CEA may be of value in the differential diagnosis of malignant and benign ovarian tumor, especially in diagnosing mucinous cystadenocarcinoma. However, due to the small amount of cases available for study, it was difficult to determine the correlation between the prognosis and tissue CEA staining of ovarian tumors.
Avidin ; Carcinoembryonic Antigen* ; Cystadenocarcinoma, Mucinous ; Cystadenocarcinoma, Serous ; Cystadenoma, Mucinous ; Cystadenoma, Serous ; Diagnosis, Differential ; Early Diagnosis ; Follow-Up Studies ; Humans ; Immunoenzyme Techniques ; Plasma* ; Prognosis

The diagnosis of ovarian tumor has been mainly dependent on manual pelvic examination and ultrasonography. Butin case of malignant ovarian tumor, CT has more advantages over ultrasonography in assessing anatomic details,relationships to bowel loops, precise extents of tumors and follow-up examinations after surgery. Authors analyzedCT features of 46 cases of patholgocially proven ovarian tumors for recent 4 years at keimyung University DongsanHospital. The results were as follows: 1. The msot common tumor was serous cystadenocarcinoma(9 cases:20%),followed by metastases(8 cases: 17%), mucinous cystadenocarcinoma(7 ases:15%), mucinous cystadenocarcinoma(5cases:11%), teratoma(5 cases:11%), lymphoma(3 cases: 7%) and dysgerminoma(2 cases:4%). 2. The ovarian tumors werevariable in size from 2.5cm to 33cm in diameter. Most of the solid tumors were smaller than 10cm in diameter andmost of the cystic tumors were larger than 10cm in diameter. Usually mucinous tumors were much larger than seroustumors. Mucinous cystadenomas were the largest tumors. 3. Unilateral tumors(left 19,right 13 cases) were morecommon than bilateral tumors(12 cases). Bilateral tumors were seen in serous and mucinous cystadenocarcinoma,metastases and lymphoma. 4. CT features of mucinous cystadenomas were smooth margins and thin wall of the tumormasses and multiloculated cysts with internal septa in all 7 cases. 5. In contrast, CT demonstration ofbilaterality, irregular margin, thick wall, enhancing solid lesions, septal irregularity, adhesion to adjacentstructures, peritoneal/omental implantation, ascites and hydronephrosis were signs suggesting malignancy. CTfeaturs of the serous cystadenocarcinoma were mostly solid to mixed nature(83%), irregular margin(75%), enhancingsolid lesion(67%), papillary growth (75%), internal septa(58%), multilocularity (58%) and calcification (25%) indescending order of frequency. 6. On CT, mucinous cystadenocarcinoma were irregular-marginated, thick-walled,cystic tumors with enhancing solid lesion, septal irregularity and signs of metastasis, although there were somecases having similar features of benign. 7. Among the extrapelvic CT findings of malignant epithelial ovariantumor, peritoneal/omental implants(11 cases:79%) and ascites(10 cases:71%) were the most common, and indistinctuterus(6 cases:43%), bowel adehsion(5 cases:36%) and pseudomyxoma peritonei (2 cases) were descending order offrequency. 8. CT features of teratoma were diagnostic having at least three more of different tissue densitiesamong fat, water, soft tissue and calcific densities. Also there were thick wall (4 cases) and fat-fluid level(1case). 9. In 8 cases of ovarian metastases, there were solid type tumor smaller than 10cm in 4 cases and hugecystic in 2 cases. The site of primary cancer were stomach in 4 cases, colon , cervix, endometrium and unknown ineach one case. 10. In 3 cases of malignant lymphoma, the CT featurs were solid in appearance, smaller than 10cmand accompanied by lymphadenopathy in all cases.
Ascites ; Cervix Uteri ; Colon ; Cystadenocarcinoma, Mucinous ; Cystadenocarcinoma, Serous ; Cystadenoma, Mucinous ; Diagnosis ; Endometrium ; Female ; Follow-Up Studies ; Gynecological Examination ; Hydronephrosis ; Lymphatic Diseases ; Lymphoma ; Mucins ; Neoplasm Metastasis ; Pseudomyxoma Peritonei ; Stomach ; Teratoma ; Ultrasonography ; Water

OBJECTIVEto investigate the expression of folate receptor(FR)α in ovarian epithelial tumors and its clinopathological significance.

METHODStissue microarrays (TMAs) were constructed from 86 epithelial ovarian cancers and 29 borderline ovarian tumors, followed by the FRα expression evaluation by immunohistochemistry. FRα mRNA expression was investigated by quantitative real-time PCR using fresh-frozen tissues from 40 cases of ovarian carcinoma and 14 cases of borderline tumor. FRα expression levels in ovarian tumors were also analyzed in correlation with tumor morphology, pathogenesis and FIGO stage.

RESULTSFRα expression was detected in 40 of 86 (46.5%) of ovarian cancers, with the highest rate of expression observed in serous carcinomas (62.7%, 32/51) compared with that of the other cancer types (P = 0.000). Depending on pathogenesis type, FRα expressions in type II ovarian carcinomas were significantly higher than those in type I ovarian carcinomas (P = 0.001). Ovarian carcinomas had a tendency to express higher FRα than the borderline tumors (46.5% vs 27.6%), although statistically not significant (P = 0.074). FRα expressions in ovarian carcinomas showed no correlation with the FIGO stage (P = 0.498). However, real-time PCR showed that FRα mRNA levels were significantly higher in ovarian carcinomas compared with that of the borderline tumors (P = 0.000) and also higher in serous ovarian borderline tumors compared with mucinous type (P = 0.007).

CONCLUSIONhigher level of FRα expression occurs frequently in ovarian epithelial tumors, especially in carcinomas and ovarian serous tumors.

Adenocarcinoma, Clear Cell ; metabolism ; pathology ; Adenocarcinoma, Mucinous ; metabolism ; pathology ; Adult ; Aged ; Carcinoma, Endometrioid ; metabolism ; pathology ; Cystadenocarcinoma, Serous ; metabolism ; pathology ; Cystadenoma, Mucinous ; metabolism ; pathology ; Cystadenoma, Serous ; metabolism ; pathology ; Female ; Folate Receptor 1 ; genetics ; metabolism ; Gene Expression Regulation, Neoplastic ; Humans ; Middle Aged ; Ovarian Neoplasms ; metabolism ; pathology ; RNA, Messenger ; metabolism ; Young Adult

OBJECTIVE: To determine whether or not detailed cystic feature analysis on CT scans can assist in the differential diagnosis of pancreatic ductal adenocarcinoma (PDAC) from serous cystadenoma (SCN), mucinous cystadenoma (MCN), and a pseudocyst. MATERIALS AND METHODS: This study received Institutional Review Board approval and informed patient consent was waived. Electronic radiology and pathology databases were searched to identify patients with PDAC (n = 19), SCN (n = 26), MCN (n = 20) and a pseudocyst (n = 23) who underwent pancreatic CT imaging. The number, size, location, and contents of cysts, and the contour of the lesions were reviewed, in addition to the wall thickness, enhancement patterns, and other signs of pancreatic and peripancreatic involvement. Diagnosis was based on lesion resection (n = 82) or on a combination of cytological findings, biochemical markers, and tumor markers (n = 6). Fisher's exact test was used to analyze the results. RESULTS: A combination of the CT findings including irregular contour, multiple cysts, mural nodes, and localized thickening, had a relatively high sensitivity (74%) and specificity (75%) for differentiating PDAC from SCN, MCN, and pseudocysts (p < 0.05). Other CT findings such as location, greatest dimension, or the presence of calcification were not significantly different. CONCLUSION: The CT findings for PDAC are non-specific, but perhaps helpful for differentiation. PDAC should be included in the general differential diagnosis of pancreatic cystic neoplasms.
Adenocarcinoma/pathology/*radiography ; Adolescent ; Adult ; Aged ; Cystadenocarcinoma, Serous/pathology/*radiography ; Cystadenoma, Mucinous/pathology/*radiography ; Diagnosis, Differential ; Female ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Pancreatic Neoplasms/pathology/*radiography ; Retrospective Studies ; Sensitivity and Specificity ; *Tomography, X-Ray Computed ; Tumor Markers, Biological/analysis

OBJECTIVETo investigate the expression and promoter methylation status of p73 gene in ovarian epithelial tumors and their clinicopathological correlations.

METHODSTissue microarrays (TMA) consisting of 68 ovarian cancers, 37 ovarian borderline tumors and 21 ovarian benign tumors were constructed. p73 expression was detected by immunohistochemistry (EnVision method). Fresh-frozen tissue samples from 13 cases of ovarian carcinomas and 5 cases of borderline tumors were evaluated for the presence of p73 promoter methylation using bisulfite sequencing.

RESULTSOverall, 92.6% (63/68) ovarian carcinomas expressed p73, with a mean value of 32% (percentage of p73 positive cells in the tumor). The mean value of p73 expression rate (40%) in serous carcinoma (26/26) was higher than those of other cancer types (P = 0.006). The mean value of p73 expression rate (40%) in type II ovarian carcinoma was significantly higher than that in type I ovarian carcinoma (24%, P = 0.010). The expression of p73 was not associated with FIGO stage and histological grade (both P > 0.05). The mean values of p73 expression in ovarian borderline tumor (30/37) and benign tumor (12/21) were 16% and 15%, respectively. Of the two groups, the mean value of p73 expression rate in serous type was higher than that in mucous type (P = 0.003, P = 0.026). Ovarian carcinomas had a higher level of p73 expression than borderline tumors and benign tumors (both P < 0.05), while that between ovarian borderline tumors and benign tumors had no statistical difference (P > 0.05). Among serous tumors (49/53), the mean value of p73 expression in the carcinoma group (26/26) was significantly higher than those in the borderline tumor group (12/14) and benign tumor group (11/13; P = 0.024 and P = 0.002, respectively), while that between borderline tumor group and benign tumor group had no statistical difference (P = 0.428). Among mucous tumors (15/27), the mean value of p73 expression in carcinoma group (6/7) was higher than that in benign tumor group (1/8; P = 0.032). No statistical difference of p73 expression was seen between the carcinoma group and ovarian borderline tumor group (8/12) and between the borderline tumor group and benign tumor group (P = 0.234, P = 0.201, respectively). p73 promotor methylation was found in 8 of 13 cases of carcinomas but at different methylation levels with a mean value of 8.0%. Two of 5 ovarian borderline tumors showed detectable p73 promotor methylation with a mean value of 9.0%. Compared with the borderline tumors, ovarian carcinomas showed a similar p73 methylation level (P > 0.05). The p73 methylation level in ovarian carcinomas was not associated with histological type, pathogenetic type, histological grade and FIGO stage (all P > 0.05).

CONCLUSIONSMost of ovarian epithelial tumors express p73 protein with mean values higher in ovarian carcinomas than those in the borderline and benign tumors. Ovarian serous carcinomas have the highest expression level of p73. A simple linear correlation does not exist between the promoter methylation and protein expression of p73.

Adult ; Aged ; Cystadenocarcinoma, Mucinous ; metabolism ; pathology ; Cystadenocarcinoma, Serous ; metabolism ; pathology ; Cystadenofibroma ; metabolism ; pathology ; Cystadenoma, Mucinous ; metabolism ; pathology ; Cystadenoma, Serous ; metabolism ; pathology ; DNA Methylation ; DNA-Binding Proteins ; metabolism ; Female ; Gene Expression Regulation, Neoplastic ; Humans ; Immunohistochemistry ; Middle Aged ; Neoplasm Grading ; Neoplasm Staging ; Neoplasms, Glandular and Epithelial ; metabolism ; pathology ; Nuclear Proteins ; metabolism ; Oligonucleotide Array Sequence Analysis ; Ovarian Neoplasms ; metabolism ; pathology ; Promoter Regions, Genetic ; Tumor Protein p73 ; Tumor Suppressor Proteins ; metabolism ; Young Adult

OBJECTIVETo determine the apoptotic and proliferative activities in various ovarian epithelial tumors.

METHODSFormalin-fixed, paraffin-embedded tissues of 86 ovarian epithelial tumors, including 52 adenocarcinomas, 23 borderline tumors and 11 cystadenoma, were retrieved. Apoptotic (AI) and proliferative (PI) index were estimated using the monoclonal antibodies: M30, Ki-67 and Ki-S1 in these tumors. Quantitative assessment of AI and PI was estimated by calculating the percentage of positive cells among no less than 1000 tumor cells.

RESULTSStatistically significant difference in AI was found between benign and borderline tumors or carcinomas (P = 0.028, 0.001, respectively). Significant differences in PI, as assessed by both Ki-67 and topo IIalpha, were demonstrated between carcinomas and benign or borderline tumors (both P < 0.001). Benign tumors had both low PI and AI; borderline tumors had lower PI but higher AI, while adenocarcinomas had both high proliferative and high apoptotic rates. Among borderline tumors, serious tumors had significantly lower AI and higher PI than mucinous ones.

CONCLUSIONThe results suggest that apoptotic and proliferative activities play important roles in the pathogenesis and development of ovarian borderline and malignant tumors. The high apoptotic rate in borderline tumor may explain its relatively indolent behavior while the high proliferative rate in carcinomas tends to explain its aggressive behavior.

Antigens, Neoplasm ; Apoptosis ; Carcinoma, Endometrioid ; chemistry ; pathology ; Cell Division ; Cystadenocarcinoma, Serous ; chemistry ; pathology ; Cystadenoma, Mucinous ; chemistry ; pathology ; Cystadenoma, Serous ; chemistry ; pathology ; DNA Topoisomerases, Type II ; analysis ; DNA-Binding Proteins ; Female ; Humans ; Ki-67 Antigen ; analysis ; Ovarian Neoplasms ; chemistry ; pathology

Pseudomyxoma peritonei often have synchronous appendiceal and ovarian mucinous tumors. There has been considerable debate as to whether the ovarian tumors are secondary to the appendiceal tumor or they are independent primary ovarian tumors. It is important to reveal the primary site for treatment and prognosis of a patient. Five cases of synchronous mucinous tumors of the ovary and appendix were studied. Four cases had pseudomyxoma peritonei and pseudomyxoma ovarii. The ovarian tumors were bilateral in two cases, right in two, and left in one. The ovarian tumors were four mucinous cystadenoma of borderine malignancy and one mucinous cystadenocarcinoma, and the appendiceal tumors consisted of four mucinous tumors of borderline malignancy and one mucinous adenocarcinoma. The histology of the ovarian and appendiceal tumors was similar. Rupture of the tumor was seen in all appendiceal tumors and two ovarian tumors. It has been reported that cytokeratin 7 is a useful marker for distinguishing primary ovarian neoplasms from metastases of intestinal origin. All ovarian and appendiceal tumors showed positive reaction for broad-spectrum cytokeratin, but negative for cytokeratin 7. Based on the clinicopathologic and immunohistochemical features, it should be considered that the appendiceal tumors are primary and ovarian tumors are secondary in the synchronous presentation of the ovarian and appendiceal mucinous tumors.
Adenocarcinoma, Mucinous ; Appendix* ; Cystadenocarcinoma, Mucinous ; Cystadenoma, Mucinous ; Female ; Humans ; Keratin-7 ; Keratins ; Mucins* ; Neoplasm Metastasis ; Ovarian Neoplasms ; Ovary* ; Prognosis ; Pseudomyxoma Peritonei* ; Rupture

BACKGROUND: Cystic neoplasms of the pancreas are rare tumor with malignant potential. Preoperative differentiation of a benign versus malignant tumor is unreliable and routine testing for this purpose is questionable. Therefore an aggressive resectional approach for cystic tumor of the pancreas was a recent trend and anticipate good prognosis. METHODS: This is a retrospective analysis of 23 patients with cystic neoplasm of the pancreas between Jun.1990 and Dec.1999. Data include patient demographics, presenting symptom, operative procedure, pathologic diagnosis, perioperative morbidity and mortality, survival follow-up data. RESULTS: The mean age of patients was 33.48 years and twenty one patients were women. There were 3 serous cystadenoma, 4 mucinous cystadenoma, 2 mucinous cystadenocarcinoma, 13 SPEN, 1 ductal ectasia. Major symptoms were abdominal pain(39.1%), palpable mass(30.4%), incidental(21.7%), melena( 4.3%), hematemesis(4.3%). Tumor site were 6 head(26.1%), 3 body(13.4%), 14 tail(60.9%). Main investigations were ultrasonography and CT. Other investigation were ERCP, MRCP, cytology. Operative procedure were 12 distal pancreatectomy and splenectomy, 4 PPPD, 2 mass enucleation, 2 distal pancreatectomy, 1 PD, 1 subtotal pancreatectomy, 1 cystojejunostomy. An accurate preoperative diagnosis of tumor type was proposed 65% pancreatic cystic tumor. Mean follow-up was 27 months(range 0.8 months to 90 months). Of these 23 patients, 20 patients were alive without recurrence during mean follow-up. One patient was died due to postoperative sepsis. Two patients was dead of unrelated cause. CONCLUSION: An aggressive resectional approach for cystic tumor of the pancreas is recommend in cystic tumor of the pancreas, if medically fit to tolerate surgery.
Cholangiopancreatography, Endoscopic Retrograde ; Cystadenocarcinoma, Mucinous ; Cystadenoma, Mucinous ; Cystadenoma, Serous ; Demography ; Diagnosis ; Dilatation, Pathologic ; Female ; Follow-Up Studies ; Humans ; Mortality ; Pancreas* ; Pancreatectomy ; Pancreatic Cyst ; Prognosis ; Recurrence ; Retrospective Studies ; Sepsis ; Splenectomy ; Surgical Procedures, Operative ; Ultrasonography