Surgical management and results for cystic neoplasms of pancreas

BACKGROUNDS/AIMS: The diagnosis for cystic neoplasm of pancreas is based on the morphologic criteria through imaging studies, but the pre- and postoperative diagnoses are often inconsistent. This study aims at the analysis of clinical characteristics and the results of surgical treatments. METHODS: A retrospective review was performed on 93 patients who have undergone surgery for pancreatic cystic diseases in our hospital from January 2001 to February 2013. Among them, 69 patients were confirmed as cystic neoplasms based on pathologic findings. Their clinical manifestations, diagnostic accuracy, surgical method and complications, pathologic findings were analyzed. RESULTS: Serous cystic neoplasm was the most common (n=22), followed by mucinous cystic neoplasm (n=18), intraductal papillary mucinous tumor (n=11), solid pseudopapillary tumor (n=9), neuroendocrine tumor (n=7), and cystic lymphangioma (n=2). The most common clinical symptom is abdominal pains (49.3%). Preoperative imaging studies were consistent with pathological findings in 72% of patients. Cystic fluid CEA levels of 400 ng/ml or more were reliable to detect mucin secreting tumors. Pancreatoduodenectomy was performed for 13 cases and the remaining 54 patients were treated with left-side pancreatectomy. Malignancy was found in 9 cases (13%) of mucin secreting tumors; 5 cases (27.8%) in mucinous cystic neoplasm and 4 cases (36.4%) in intraductal papillary mucinous tumor. Two of these survived without recurrences during the follow-up periods. CONCLUSIONS: Exact treatment protocols for cystic neoplasm of pancreas are not decided because tumors are found with atypical forms. Surgical management is suggested for resectable tumors because a good prognosis can be expected with proper surgery if precancerous lesions are suspected at the time of discovery.

Tumor sólido quístico pseudopapilar del páncreas: reporte del primer caso en Cuba / First clinical report from Cuba of solid-pseudopapillary tumors of the pancreas

Se presenta el caso de una paciente de 21 años de edad, portadora de un tumor sólido quístico pseudopapilar del páncreas. Se hace una revisión de los aspectos clínicos, diagnósticos y terapéuticos de esta rara neoplasia; al mismo tiempo, se hace énfasis en la anatomía patológica y en su diagnóstico diferencial. Esta es una entidad propia de mujeres jóvenes, sin embargo, en la actualidad ha incrementado su frecuencia, con variación en los aspectos clásicos del comportamiento clínico.

The case of a 21-year female patient with a solid-pseudopapillary tumor of the Pancreas is presented. Clinical, histopathological, diagnostic and therapeutic features of this rare tumor are presented and discussed with emphasis on pathology and differential diagnosis. This rare entity most frequently affects young women, but its incidence has increasing, and there have been changes its clinical behavior from those classically reported.