Pancreatic malignancy is the third leading cause of cancer related death in the United States with limited viable screening options. By the end of this decade, cancers are poised to become the leading cause of death with pancreatic cancer projected to be the second leading cause of cancer related mortality. Pancreatic cystic lesions (PCLs) are found in approximately 5%–14% of patients due to the increased utilization of cross-sectional imaging, with approximately 8%–10% of pancreatic cancers originating as PCLs. Current screening guidelines have shown discrepancies between morphologic characteristics of PCLs and identifying advanced pancreatic disease. Molecular analysis has emerged as a novel technology to aid in adequate diagnosis and management decisions of PCLs. Mucinous cysts including intraductal papillary mucinous neoplasms (IPMNs) or mucinous cystic neoplasms have similar oncogenic mutations including KRAS, TP53, SMAD4, PIK3CA, PTEN, or CKDN2A, while GNAS and RNF43 mutations are specific only to IPMNs. Serous cystadenomas have been associated with a loss of tumor suppressor gene VHL, while solid-psuedopapillary neoplasms have an oncogenic mutation CTNNB1. A specific molecular marker to diagnose existing high-grade dysplasia or impending malignant transformation is yet to be identified. Moving forward it is important to advance technology in isolating and identifying high-risk molecular markers from cyst fluid while considering their increased utilization in the evaluation of PCLs.
Biomarkers, Tumor ; Cause of Death ; Cyst Fluid ; Cystadenoma, Serous ; Diagnosis ; Genes, Tumor Suppressor ; Humans ; Loss of Heterozygosity ; Mass Screening ; Mortality ; Mucins ; Neoplasms, Cystic, Mucinous, and Serous ; Pancreatic Cyst* ; Pancreatic Diseases ; Pancreatic Neoplasms ; United States

Mucinous cystadenomas and cystadenocarcinomas of the ovary are clinically and histopathologically well-established common tumors. However, primary retroperitoneal mucinous cystic tumors are extremely rare, and although their histopathogenesis is still uncertain, several theories have been proposed. Most authors suggest that they develop through mucinous metaplasia in a preexisting mesothelium-lined cyst. An accurate preoperative diagnosis of these tumors is difficult because no effective diagnostic measures have been established. Delay in diagnosis and treatment of this tumor may be fatal for the patient because of complications such as rupture, infection, and malignant transformation. We describe the case of a 31-year-old woman with abdominal pain and a palpable mass. Computed tomography of the abdomen revealed a retroperitoneal cystic mass, which was resected successfully through laparoscopy. Histopathological examination of the resected mass confirmed the diagnosis of a primary retroperitoneal mucinous cystadenoma. The patient was discharged on postoperative day 5 without any complications.
Abdomen ; Abdominal Pain ; Adult ; Cystadenocarcinoma ; Cystadenoma, Mucinous* ; Diagnosis ; Female ; Humans ; Laparoscopy ; Metaplasia ; Mucins* ; Ovary ; Retroperitoneal Neoplasms ; Rupture

No abstract available.
Animals ; Biopsy ; Clonorchiasis/diagnosis/*parasitology ; Clonorchis sinensis/*isolation & purification ; Cystadenoma, Mucinous/*parasitology/pathology/surgery ; Foodborne Diseases/diagnosis/*parasitology ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pancreatectomy ; Pancreatic Neoplasms/*parasitology/pathology/surgery ; Seafood/*parasitology ; Tomography, X-Ray Computed ; Treatment Outcome

Cystadenoma rarely arises in the parotid gland. It grows slowly without pain. Histopathologically, it is subdivided into papillary cystadenoma and mucinous cystadenoma. Mucinous cystadenoma arising from the salivary gland is a very rare benign tumor. A 25-year-old female patient visited our hospital with a left infra-auricular mass. Computed tomography scan showed a 3.1x2.3 cm size heterogeneous lesion with an irregular margin in the left parotid gland. Sono guided gun biopsy was performed to reveal fibrous tissue with atypical epithelial cell with mucin. Suspecting mucoepidermoid carcinoma, partial parotidectomy was performed for treatment and diagnosis. Histopathologic exam revealed mucinous cystadenoma. Cystadenoma of salivary gland has no distinct clinical feature, and is difficult to differentiate clinically from other salivary gland tumors as well as its malignancy. Thus, the possibility of malignancy must be considered for differential diagnosis.
Adult ; Biopsy ; Carcinoma, Mucoepidermoid* ; Cystadenoma ; Cystadenoma, Mucinous* ; Cystadenoma, Papillary ; Diagnosis ; Diagnosis, Differential ; Epithelial Cells ; Female ; Humans ; Mucins* ; Parotid Gland* ; Salivary Glands

Primary retroperitoneal mucinous cystadenoma is an extremely uncommon tumor, even though mucinous cystadenoma often develops in the ovary and less frequently in the pancreas. A 21-year-old female was admitted to our hospital due to severe abdominal pain. A well-demarcated, oval shaped cystic tumor at the retropancreatic area with displacement of the pancreas and surrounding major vessels was observed on CT and MRI. Exploratory laparotomy was performed, and complete excision of the entire cyst was performed without complication. The pathologic finding was consistent with primary retropancreatic mucinous cystadenoma. To the best of our knowledge, this report is the first to describe a case of retropancreatic mucinous cystadenoma arising from the retropancreatic area in Korea.
Antibodies/metabolism ; Cystadenoma, Mucinous/*diagnosis/pathology/surgery ; Female ; Humans ; Magnetic Resonance Imaging ; Mucin 5AC/immunology ; Mucin-2/immunology ; Ovarian Neoplasms/*diagnosis/pathology/surgery ; Retroperitoneal Neoplasms/*diagnosis/pathology/surgery ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVE: To describe the computed tomography (CT) features of neuroendocrine tumors (NETs) and solid pseudopapillary tumors (SPTs) with unilocular cyst-like appearance, and to compare them with those of unilocular cystic tumors of the pancreas. MATERIALS AND METHODS: This retrospective study was approved by our Institutional Review Board, and informed consent was waived. We included 112 pancreatic tumors with unilocular cyst-like appearance on CT (16 solid tumors [nine NETs and seven SPTs] and 96 cystic tumors [45 serous cystadenomas, 30 mucinous cystic neoplasms, and 21 branch-duct intraductal papillary mucinous neoplasms]). Two radiologists reviewed the CT images in consensus to determine tumor location, long diameter, morphological features, wall thicknesses, ratio of wall thickness to tumor size, wall enhancement patterns, intratumoral contents, and accompanying findings. Fisher's exact test was used to analyze the results. RESULTS: All 16 solid tumors had perceptible walls (mean thickness, 2.7 mm; mean ratio of wall thickness to tumor size, 7.7%) with variable enhancement. Four NETs and seven SPTs had hemorrhage, calcifications, and/or mural nodules. Six CT findings were specific for solid tumors with unilocular cyst-like appearance: a thick (> 2 mm) wall, uneven thickness of the wall, high ratio of wall thickness to tumor size, hyper- or hypo-attenuation of the wall in the arterial and portal phase, and heterogeneous internal contents. When three or more of the above criteria were used, 100% specificity and 87.5-92% accuracy were obtained for solid tumors with unilocular cyst-like appearance. CONCLUSION: A combination of CT features was useful for distinguishing solid tumors with unilocular cyst-like appearance from unilocular cystic tumors of the pancreas.
Adenocarcinoma, Mucinous/diagnosis/*radiography ; Adult ; Aged ; Carcinoma, Papillary/diagnosis/*radiography ; Cystadenoma, Serous ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Neuroendocrine Tumors/diagnosis/*radiography ; Pancreatic Neoplasms/diagnosis/*radiography ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed

We report MR imaging findings of a rare case of endocervical mucinous borderline tumor (MBT) involving the cul-de-sac and left fallopian tube arising from extensive pelvic endometriosis with pathologic correlation in a 35-year-old woman presented with vague pelvic pain. Endocervical MBT is a type of endometriosis-associated carcinoma. Imaging findings of endocervical MBT are unilocular or oligolocular cystic lesions with enhancing mural nodules, which are different from those of the more common intestinal type MBT.
Adult ; Cystadenoma, Mucinous/*diagnosis/etiology ; Diagnosis, Differential ; Endometriosis/complications/*diagnosis ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging/*methods ; Ovarian Neoplasms/*diagnosis/etiology ; Pelvis ; Precancerous Conditions/*diagnosis/etiology

OBJECTIVETo assess the value of multi-slice computed tomography (MSCT) in the diagnosis and differential diagnosis of pancreatic mucinous cystic neoplasms and serous cystadenoma.

METHODThe MSCT images were reviewed for 19 pathologically confirmed cases of pancreatic mucinous cystadenomas and 13 cases of pancreatic serous cystadenomas (n=13) treated in our center between July, 2003 and December, 2009. The CT features were analyzed including the tumor location, contour, dimension of the largest cyst, cystic wall, septation, presence of calcification, solid component, pancreatic atrophy, main pancreatic duct dilatation, and lesion margins.

RESULTSSignificant differences were found between the two groups in lesion diameter (P=0.009), cyst distribution of the largest cyst (>2 cm) (P=0.01), and the presence of solid component (P=0.02).

CONCLUSIONMSCT can be of important value in the diagnosis and differential diagnosis of pancreatic mucinous cystic neoplasms and serous cystadenomas.

Adult ; Aged ; Cystadenoma, Mucinous ; diagnostic imaging ; Cystadenoma, Serous ; diagnostic imaging ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Multidetector Computed Tomography ; methods ; Pancreatic Neoplasms ; diagnostic imaging ; Retrospective Studies

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

Herein, we present two cases of Brenner tumor, a rarely occurring neoplasm in the ovaries, obtained via intraoperative fine needle aspiration. The borderline Brenner tumor exhibited marked squamous metaplasia, characterized by individually distributed atypical squamous cells. A benign Brenner tumor associated with mucinous cystadenoma evidenced typical mucinous metaplastic features and transitional foci. These distinctive features may prove helpful in differential diagnosis of varied ovarian tumors, and particularly for intraoperative consultation.
Biopsy, Fine-Needle ; Brenner Tumor ; Cystadenoma, Mucinous ; Diagnosis, Differential ; Female ; Metaplasia ; Mucins ; Ovary