Cancer Treatment Reviews
Volume 31, Issue 7 , Pages 507-535 , November 2005

Cystic neoplasms of the pancreas; What a clinician should know

  • George H. Sakorafas

      Affiliations

    • Department of Surgery, 251 Hellenic Air Force (HAF) Hospital, Messogion and Katehaki Avenue, 115 25 Athens, Greece
    • Corresponding Author InformationCorresponding author. Tel.: +30 210 74 87 318; fax: +30 210 74 87 192.
  • ,
  • Michael G. Sarr

      Affiliations

    • James C. Masson Professor of Surgery, Department of Surgery, Mayo Clinic College of Medicine, Alfred Building, Room 2-435, 200 First Street S.W., Rochester, MN 55905, USA
    • Tel.: +1 507 255 5713; fax: +1 507 255 6318.

References 

  1. Horvath KD, Chabot JA. An aggressive resectional approach to cystic neoplasms of the pancreas. Am J Surg. 1999;178:269–274
  2. Haban M. Papillomatose und carcinom des gangsystems der bauchspeicheldruse. Virchows Arch A Pathol Anat. 1936;297:207–220
  3. Compagno J, Oertel JE. Mucinous cystic neoplasms of the pancreas with overt and latent malignancy (cystadenocarcinoma and cystadenoma). A clinicopathologic study of 41 cases. Am J Clin Pathol. 1978;69:573–580
  4. Compagno J, Oertel JE. Microcystic adenomas of the pancreas (glycogen-rich cystadenomas): a clinicopathologic study of 34 cases. Am J Clin Pathol. 1978;69:289–298
  5. Ohhashi K, Murakami Y, Takekoshi T, et al. Four cases of mucin producing cancer of the pancreas on specific findings of the papilla of Vater. Prog Dig Endosc. 1982;20:348–351
  6. Sarr MG, Murr M, Smyrk T, et al. Primary cystic neoplasms of the pancreas: neoplastic disorders of emerging importance – current state-of-the-art and unanswered questions. J Gastrointest Surg. 2003;7:417–428
  7. Brugge WR, Lauwers GY, Sahani D, et al. Cystic neoplasms of the pancreas. N Engl J Med. 2004;351:1218–1226
  8. Megibow AJ, Lombardo FP, Guiarise A, et al. Cystic masses: cross-sectional imaging observations and serial follow-up. Abdom Imaging. 2001;26:640–647
  9. Sakorafas GH, Sarr MG. Cystic neoplasms of the pancreas. In:  Bland KI,  Sarr MG editor. The practice of general surgery. Philadelphia: W.B. Saunders; 2002;p. 771–776
  10. Le Borgne J, De Calan L, Partensky C. Les tumeurs Kystiques du Pancreas. In: Monographie de l’ Association Francaise de Chirurgie. vol. 1:Paris: Arnette; 1997;
  11. Fernandez-del Castillo C, Warshaw AL. Cystic tumors of the pancreas. Surg Clin North Am. 1995;75:1001–1016
  12. Sarr MG, Kendrick ML, Nagorney DM, et al. Cystic neoplasms of the pancreas. Benign to malignant epithelial neoplasms. Surg Clin North Am. 2001;81:497–509
  13. Le Borgne J, de Calan L, Partensky C, et al. Cystadenomas and cystadenocarcinomas of the pancreas. A multi-institutional retrospective study of 398 cases. Ann Surg. 1999;230:152–161
  14. Sarr MG, Carpenter HA, Prabhakar LP, et al. Clinical and pathologic correlation of 84 mucinous cystic neoplasms of the pancreas – can one reliably differentiate benign from malignant (or premalignant) neoplasms?. Ann Surg. 2000;231:205–212
  15. Sarr MG, Prabhakar LP, Loftus EV. The spectrum of cystic neoplasms including mucinous ductal ectasia. In: Advances in pancreatic disease. New York: Thieme; 1996;p. 352–370
  16. Warshaw AL, Compton CC, Lewandrsowski K, et al. Cystic tumors of the pancreas: new clinical, radiologic, and pathologic observations in 67 patients. Ann Surg. 1990;212:432–443
  17. Thompson LDR, Becker RC, Przygodzki RM, et al. Mucinous cystic neoplasm (mucinous cystadenocarcinoma of low grade malignant potential) of the pancreas. Am J Surg Pathol. 1999;23:1–16
  18. Loftus EV, Olivares-Pakzad BA, Batts KP, et al. Intraductal papillary-mucinous tumors of the pancreas: clinicopathologic features, outcome, and nomenclature. Gastroenterology. 1996;110:1909–1918
  19. Sugiyama M, Atomi Y. Intraductal papillary mucinous tumors of the pancreas: imaging studies and treatment strategies. Ann Surg. 1998;228:685–691
  20. Itai Y, Ohhashi K, Nagai H. “Ductectatic” mucinous cystadenoma and cystadenocarcinoma of the pancreas. Radiology. 1986;161:697–700
  21. Talamini MA, Pitt HA, Hruban RH, et al. Spectrum of cystic tumors of the pancreas. Am J Surg. 1992;163:117–124
  22. Grieshop NA, Wiebke EA, Kratzer SS, et al. Cystic neoplasms of the pancreas. Am Surg. 1994;60:509–515
  23. De Calan L, Levrard H, Hennet H, et al. Pancreatic cystadenoma and cystadenocarcinoma: diagnostic value of preoperative morphological investigations. Eur J Surg. 1995;161:35–40
  24. Talamani MA, Fuishman EK, Hruban RH, Pitt HA. Cystic neoplasms. In: The team approach to management. Boston: Little, Brown & Company; 1995;p. 451–461
  25. Leung KL, Lau WY, Cooper JE. Mucinous cystadenocarcinoma of the pancreas: an uncommon presentation with hemobilia. Gastrointest Endosc. 1994;632–634
  26. Baruch M, Levy Y, Goldsher D, et al. Massive hematemesis presenting sympton of cystadenocarcinoma of the pancreas. Postgrad Med J. 1989;65:42–44
  27. Yamaguchi K, Ogawa Y, Chijiiwa K, Tanaka M. Mucin hypersecreting tumors of the pancreas: assessing the grade of malignancy preoperatively. Am J Surg. 1996;171:427–431
  28. Sarr MG, Sakorafas GH. Cystic neoplasms of the pancreas. In:  Dervenis C editors. Advances in the management of pancreatic malignancies. Germany: Springer; 2000;p. 297–303
  29. Martin I, Hammond P, Scott J, et al. Cystic tumors of the pancreas. Br J Surg. 1998;85:1484–1486
  30. Yeo CJ, Sarr MG. Cystic and pseudocystic diseases of the pancreas. Curr Probl Surg. 1994;31:162–252
  31. Sakorafas GH, Sarr MG. Primary cystic neoplasms of the pancreas (Chapter). In: Yeo CJ, editor. Shackelford’s surgery of the alimentary tract, 6th ed., W.B. Saunders [in press].
  32. George DH, Murphy F, Michalski R, Ulmer BG. Serous cystadenocarcinoma of the pancreas – a new entity. Am J Surg Pathol. 1989;13:61–66
  33. Ohta T, Nagakawa T, Itho H, et al. A case of serous cystadenoma of the pancreas with focal malignant changes. Int J Pancreatol. 1993;14:283–289
  34. Pyke CM, van Heerden JA, Colby TV, Sarr MG. The spectrum of serous cystadenoma of the pancreas. Ann Surg. 1992;215:132–139
  35. Nodell CG, Freeny PC, Dale DH, et al. Serous cystadenoma of the pancreas with a metachronous adenocarcinoma. Am J Roentgenol. 1994;162:1352–1354
  36. Remise SC, Frey D, Rossi RL, et al. Cystic neoplasms of the pancreas. Arch Surg. 1987;122:443–446
  37. Zamboni G, Scarpa A, Bogina G, et al. Mucinous cystic tumors of the pancreas: clinicopathological features, prognosis, and relationship to other mucinous cystic tumors. Am J Surg Pathol. 1999;23:410–422
  38. Wilentz RE, Albores-Saavedra J, Hruban RH. Mucinous cystic neoplasms of the pancreas. Semin Diagn Pathol. 2000;17:31–42
  39. Hodgkinson DJ, ReMine WH, Weiland LH. A clinicopathologic study of 21 cases of pancreatic cystadenocarcinoma. Ann Surg. 1978;188:679–684
  40. Adsay NV, Merati K, Basturk O, et al. Pathologically and biologically distinct types of epithelium in intraductal papillary mucinous neoplasms. Am J Surg Pathol. 2004;28:839–848
  41. Adsay NV. The “new kid on the block”: intraductal papillary mucinous neoplasms of the pancreas: current concepts and controversies. Surgery. 2003;133:459–463
  42. Hamilton SR, Aaltonen LA. World Health Organization classification of tumours. Tumours of the digestive system. Lyon: IARC Press; 2000;p. 234–40
  43. Kloppel G, Luttges J. WHO classification 2000: exocrine pancreatic tumors. Verh Dtsch Ges Pathol. 2001;85:219–228
  44. Barbe L, Ponsot P, Vilgrain V, et al. Intraductal papillary mucinous tumors of the pancreas: clinical and morphological aspects in 30 patients. Gastroenterol Clin Biol. 1997;21:278–286
  45. Cellier C, Cuillerier E, Palazzo L, et al. Intraductal papillary and mucinous tumors of the pancreas. Gastrointest Endosc. 1998;47:42–49
  46. Fukushima N, Mukai K, Kanai Y, et al. Intraductal papillary tumors and mucinous cystic tumors of the pancreas: clinicopathological study of 38 cases. Hum Pathol. 1997;28:1010–1017
  47. Kobari M, Egawa S, Shibuya K, et al. Intraductal papillary mucinous tumors of the pancreas comprise 2 clinical subtypes: differences in clinical characteristics and surgical management. Arch Surg. 1999;134:1131–1136
  48. Paal E, Thompson LD, Przygodszki RM, et al. A clinicopathologic and immunohistochemical study of 22 intraductal papillary mucinous neoplasms of the pancreas, with a review of the literature. Mod Pathol. 1999;12:518–528
  49. Siech M, Tripp K, Schmidt-Rohlfing B, et al. Intraductal papillary mucinous tumor of the pancreas. Am J Surg. 1999;177:117–120
  50. Ohhashi K, Murakimi Y, Muruyama M, et al. Four cases of mucous secreting pancreatic cancer. Prog Dig Endosc. 1982;20:348–351
  51. Furukawa T, Takahashi T, Kobari M, Matsuno S. The mucous-hypersecreting tumor of the pancreas. Cancer. 1992;70:1505–1513
  52. Wada K, Takada T, Yasuda H, et al. Does “clonal progression” relate to the development of intraductal papillary mucinous tumors of the pancreas. J Gastrointest Surg. 2004;8:289–296
  53. Adsay NV, Conlon KC, Zee SY, et al. Intraductal papillary-mucinous neoplasms of the pancreas: an analysis of in situ and invasive carcinomas in 28 patients. Cancer. 2002;94:62–77
  54. Nakamura A, Horinouchi M, Goto M, et al. New classification of pancreatic intraductal papillary-mucinous tumour by mucin expression: its relationship with potential for malignancy. J Pathol. 2002;197:201–210
  55. Yonezawa S, Horinouchi M, Osako M, et al. Gene expression of gastric type mucin (MUC5AC) in pancreatic tumors: its relationship with the biological behavior of the tumor. Pathol Int. 1999;49:45–54
  56. Yonewaza S, Nakamura A, Horinouchi M, et al. The expression of several types of mucin is related to the biochemical behavior of pancreatic neoplasms. J Hepatobil Pancreat Surg. 2002;9:328–341
  57. Yonewaza S, Taira M, Osako M, et al. MUC1 mucin expression in invasive areas of intraductal papillary mucinous tumors of the pancreas. Pathol Int. 1998;48:319–322
  58. Luttges J, Feyerabend B, Buchelt T, et al. The mucin profile of noninvasive and invasive mucinous cystic neoplasms of the pancreas. Am J Surg Pathol. 2002;26:466–471
  59. Luttges J, Zamboni G, Longnecker D, et al. The immunohistochemical mucin expression pattern distinguishes different types of intraductal papillary mucinous neoplasms of the pancreas and determines their relationship to mucinous noncystic carcinoma and ductal adenocarcinoma. Am J Surg Pathol. 2001;25:942–948
  60. Adsay NV, Longnecker DS, Klimstra DS. Pancreatic tumors with cystic dilation of the ducts: intraductal papillary mucinous neoplasms and intraductal oncocytic papillary neoplasms. Semin Diag Pathol. 2000;17:16–30
  61. Fearon ER, Vogelstein B. A genetic model for colorectal tumorigenesis. Cell. 1990;61:759–767
  62. Z’graggen K, Rivera JA, Compton CC, et al. Prevalence of activating K-ras mutations in the evolutionary stages of neoplasia in intraductal papillary mucinous tumors of the pancreas. Ann Surg. 1997;226:491–500
  63. Satoh K, Shimosegawa T, Moriizumi S, et al. K-ras mutation and p53 protein accumulation in intraductal mucin hypersecreting neoplasms of the pancreas. Pancreas. 1996;12:362–368
  64. Sakorafas GH, Tsiotos GG. Molecular biology of pancreatic cancer: potential clinical implications. BioDrugs. 2001;15:439–452
  65. Tada M, Omata M, Ohto M. Ras gene mutations in intraductal papillary neoplasms of the pancreas. Analysis of five cases. Cancer. 1991;67:634–637
  66. Moskaluk CA, Hruban RH, Kern SE. p16 and K-ras gene mutations in the intraductal precursors of human pancreatic adenocarcinoma. Cancer Res. 1997;57:2140–2143
  67. Fujii H, Inagaki M, Kasai K, et al. Genetic progression and heterogeneity in intraductal papillary-mucinous neoplasms of the pancreas. Am J Pathol. 1997;151:1447–1454
  68. Biankin AV, Biankin SA, Kench JG, et al. Aberrant p16(INK4A) and DPC4/Smad4 expression in intraductal papillary mucinous tumours of the pancreas is associated with invasive ductal adenocarcinoma. Gut. 2002;50:861–868
  69. Sessa F, Solcia E, Capella C, et al. Intraductal papillary-mucinous tumours represent a distinct group of pancreatic neoplasms: an investigation of tumour cell differentiation and K-ras, p53, and c-erbB-2 abnormalities in 26 patients. Virchows Arch. 1994;425:357–367
  70. Kawahira H, Kobayashi S, Kaneko K, et al. p53 protein expression in intraductal papillary mucinous tumours (IPMT) of the pancreas as an indicator of tumor malignancy. Hepatogastroenterology. 2000;47:973–977
  71. Wada K. p16 and p53 alterations and accumulations in the malignant evolution of intraductal papillary-mucinous tumours of the pancreas. J Hepatobil Pancreat Surg. 2002;9:76–85
  72. Sakorafas GH. Molecular biology of pancreatic cancer. How useful is it for the clinician. Iatriki (GR). 2001;79:337–342
  73. Kondo H, Sugano K, Fukayama N, et al. Detection of K-ras gene mutations at codon 12 in the pancreatic juice of patients with intraductal papillary mucinous tumors of the pancreas. Cancer. 1997;79:900–905
  74. Kloppel G. Clinicopathologic view of intraductal papillary-mucinous tumor of the pancreas. Hepatogastroenterology. 1998;45:1981–1985
  75. Longnecker DS. Observations on the etiology and pathogenesis of intraductal papillary-mucinous neoplasms of the pancreas. Hepatogastroenterology. 1998;45:1973–1980
  76. Luttges J, Beyser K, Pust S, et al. Pancreatic mucinous non-cystic (colloid) carcinomas and intraductal papillary mucinous carcinomas are usually microsatellite stable. Mod Pathol. 2003;16:537–542
  77. Terris B, Ponsot P, Paye F, et al. Intraductal papillary mucinous tumors of the pancreas confined to secondary ducts show less aggressive pathologic features as compared with those involving the main pancreatic duct. Am J Surg Pathol. 2000;24:1372–1377
  78. Taouli B, Vilrain V, Vullierme M-P, et al. Intraductal papillary mucinous tumors of the pancreas: helical CT with histopathological correlation. Radiology. 2000;217:757–764
  79. Traverso LW, Peralta EA, Ryan JA, Kozarek RA. Intraductal neoplasms of the pancreas. Am J Surg. 1998;175:426–432
  80. Chari ST, Raimonto M, Clain JE, et al. Is benign pancreatic intraductal papillary tumor (IPMT) truly benign. Gastroenterology. 2000;18(Suppl 1):A642
  81. Andea AA, Cheng J, Lauwers GY, Klimstra DS. Assay in pancreatic intraepithelial neoplasia (Panin) in pancreata involved by mucinous cystic neoplasm. Mod Pathol. 2002;15:282A
  82. Katoh H, Russi RL, Braasch JW, et al. Cystadenoma and cystadenocarcinoma of the pancreas. Hepatogastroenterology. 1989;36:424–430
  83. Delcore R, Thomas JH, Forster J, et al. Characteristics of cystic neoplasms of the pancreas and results of aggressive surgical treatment. Am J Surg. 1992;164:437–442
  84. Siech M, Tripp K, Schmidt-Rohfiing B, et al. Cystic tumors of the pancreas: diagnostic accuracy, pathologic observations, and surgical consequences. Langenbecks Arch Surg. 1998;383:56–61
  85. Le Borgne J. Cystic tumours of the pancreas. Br J Surg. 1998;85:577–579
  86. Sahani D, Prasad S, Saini S, Mueller P. Cystic pancreatic neoplasms evaluation by CT and magnetic resonance cholangiopancreatography. Gastrointest Endosc Clin North Am. 2002;12:657–672
  87. Michael H, Gress F. Diagnosis of cystic neoplasms with endoscopic ultrasound. Gastrointest Endosc Clin North Am. 2002;12:719–733
  88. Gandolfi L, Torresan F, Solmi L, Puccetti A. The role of ultrasound in biliary and pancreatic diseases. Eur J Ultrasound. 2003;16:141–159
  89. Visser BC, Muthusamay VR, Mulvihill SJ, Coakley F. Diagnostic imaging of cystic pancreatic neoplasms. Surg Oncol. 2004;13:27–39
  90. Choe KA. Intraductal papillary mucinous tumors and mucinous cystic tumors of the pancreas: imaging. J Hepatobil Pancreat Surg. 2003;10:137–141
  91. Mathieu D, Guigui B, Valetter PJ, et al. Pancreatic cystic neoplasms. Radiol Clin North Am. 1989;27:163–176
  92. Johnson CD, Stephens DH, Charboneau JW, et al. Cystic pancreatic tumors: CT and sonographic assessment. Am J Radiol. 1988;151:1133–1138
  93. Kimura W, Sasahira N, Yoshikawa T, et al. Duct-ectatic type of mucin producing tumor of the pancreas. New concepts of pancreatic neoplasia. Hepatogastroenterology. 1996;43:692–709
  94. Shima Y, Mori M, Takakura N, et al. Diagnosis and management of cystic pancreatic tumors with mucin production. Br J Surg. 2000;87:1041–1047
  95. Sugiyama M, Atomi Y, Kuroda A. Two types of mucin-producing cystic tumors of the pancreas: diagnosis and treatment. Surgery. 1997;122:617–625
  96. Kimura W, Kuroda A, Makuuchi M. Problems in the diagnosis and treatment of a so-called mucin-producing tumor of the pancreas. Pancreas. 1998;16:363–369
  97. Obara T, Maguchi H, Saitoh Y, et al. Mucin-producing tumor of the pancreas: surgery or follow-up. Nippon Shokakibyo Gakkai Zasshi. 1994;91:66–74
  98. Yamao K, Nakamure T, Suzuki T, et al. Endoscopic diagnosis and staging of mucinous cystic neoplasms and intraductal papillary-mucinous tumors. J Hepatobil Pancreat Surg. 2003;10:142–146
  99. Megibow AJ, Lavelle MT, Rofsky NM. Cystic tumors of the pancreas. Surg Clin North Am. 2001;81:489–495
  100. Fukukura Y, Fujiyoshi F, Hamada H, et al. Intraductal papillary mucinous tumors of the pancreas. Comparison of helical CT and MR imaging. Acta Radiol. 2003;44:464–471
  101. Tanaka M. Intraductal papillary mucinous neoplasm of the pancreas: diagnosis and treatment. Pancreas. 2004;28:282–288
  102. Sugiyama M, Atomi Y, Hachiya J. Intraductal papillary tumors of the pancreas. Evaluation with magnetic resonance cholangiopancreatography. Am J Gastroenterol. 1998;93:156–159
  103. Arakawa A, Yamashita Y, Namimoto T, et al. Intraductal papillary tumors of the pancreas. Histopathologic correlation of MR cholangiopancreatography findings. Acta Radiol. 2000;41:343–347
  104. Gress F, Gottlieb K, Cummings O, et al. Endoscopic ultrasound characteristics of mucinous cystic neoplasms of the pancreas. Am J Gastroenterol. 2000;95:961–965
  105. Ahmad NA, Kochman ML, Lewis JD, et al. Can EUS alone differentiate between malignant and benign cystic lesions of the pancreas. Am J Gastroenterol. 2001;96:3295–3300
  106. Koito K, Namieno T, Nagakawa T, et al. Solitary cystic tumor of the pancreas: EUS-pathologic correlation. Gastrointest Endosc. 1997;45:268–276
  107. Song MH, Lee SK, Kim MH, et al. EUS in the evaluation of pancreatic cystic lesions. Gastrointest Endosc. 2003;57:891–896
  108. Sedlack R, Affi A, Vasquez-Sequeiros E, et al. Utility of EUS in the evaluation of cystic pancreatic lesions. Gastrointest Endosc. 2002;56:543–547
  109. Brugge WR, Lewandrowski K, Lee-Lewandrowski E, et al. Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology. 2004;126:1330–1336
  110. Brandwein SL, Farrell KK, Centeno BA, et al. Detection and tumor staging of malignancy in cystic, intraductal, and solid tumors of the pancreas by EUS. Gastrointest Endosc. 2001;53:722–777
  111. Freeny PC, Weinstein CJ, Taft DA, Allen FH. Cystic neoplasms of the pancreas: new angiographic and ultrasonographic findings. Am J Roetgenol. 1978;131:795–802
  112. Scott J, Martin I, Redhead D, et al. Mucinous cystic neoplasms of the pancreas: imaging features and diagnostic difficulties. Clin Radiol. 2000;53:187–192
  113. Sakorafas GH, Farnell MB, Nagorney DM, Farley DR, Que FG, Donohue JH, et al. Management of peri-pancreatic vasculature during pancreatoduodenectomy: tips to avoid severe haemorrhage. Eur J Surg Oncol. 1999;25:524–528
  114. Yamao K, Okubo K, Sawaka A, et al. Endoluminal ultrasonography in the diagnosis of pancreatic diseases. Abdom Imaging. 2003;28:545–555
  115. Telford JJ, Carr-Locke DL. The role of ERCP and pancreatoscopy in cystic and intraductal tumors. Gastrointest Endosc Clin N Am. 2002;12:747–757
  116. Vasquez-Sequeiros E, Wiersema MJ. Peroral pancreatoscopy and intraductal ultrasound for diagnosis of intraductal papillary mucinous tumors of the pancreas. Am J Gastroenterol. 2002;97:2915–2917
  117. Hara T, Yamaguchi T, Ishibara T, et al. Diagnosis and patient management of intraductal papillary mucinous tumor of the pancreas by using peroral pancreatoscopy and intraductal ultrasonography. Gastroenterology. 2002;122:34–43
  118. Recine M, Kaw M, Evans D, Krishnamurthy S. Fine-needle aspiration cytology of mucinous tumors of the pancreas. Cancer (Cancer Cytopathol). 2004;102:92–99
  119. Dodd LG, Farrell TA, Layfield LJ. Mucinous cystic tumor of the pancreas: an analysis of FNA characteristics with an emphasis on the spectrum of malignancy associated features. Diagn Cytopathol. 1995;12:113–119
  120. Mallery JS, Centeno BA, Hahn PF, et al. Pancreatic tissue sampling guided by EUS, CT/US, and surgery: a comparison of sensitivity and specificity. Gastrointest Endosc. 2002;56:218–224
  121. Rhodes I, Humar A, Lum PA, et al. Computed tomographic and cytologic assessment of cystic pancreatic neoplasms: a difficult preoperative diagnosis. Can Assoc Radiol K. 1993;44:359–363
  122. Centeno BA, Warshaw AL, Mayo-Smith W, et al. Cytologic diagnosis of pancreatic cystic lesions. A prospective study of 28 percutaneous aspirates. Acta Cytol. 1997;41:972–980
  123. Sperti C, Pasquali C, Pedrazzoli S, et al. Expression of mucin-like carcinoma-associated antigen in the cyst fluid differentiates mucinous from non-mucinous pancreatic cysts. Am J Gastroenterol. 1997;92:672–675
  124. Lewandrowski KB, Southern JF, Pins MR, et al. Cyst fluid analysis in the differential diagnosis of pancreatic cysts: a comparison of pseudocysts, serous cystadenomas, mucinous cystic neoplasm, and mucinous cystadenocarcinomas. Ann Surg. 1993;217:41–47
  125. Young NA, Villani MA, Khoury P, et al. Differential diagnosis of cystic neoplasms of the pancreas by fine-needle aspiration. Arch Pathol Lab Med. 1995;115:571–577
  126. Jones EC, Suen KC, Grant DR, Chan NH. Fine-needle aspiration cytology of neoplastic cysts of the pancreas. Diagn Cytopathol. 1987;3:238–243
  127. Shorten SD, Hart WR, Petras RE. Microcystic adenomas (serous cystadenomas) of pancreas: a clinical investigation of eight cases with immunohistochemical and ultrastructural studies. Am J Surg Pathol. 1986;10:365–372
  128. Sperti C, Cappellazzo F, Pasquali C, et al. Cystic neoplasms of the pancreas: problems in differential diagnosis. Am Surg. 1993;59:740–745
  129. Albores-Saavedra J, Angeles-Angeles A, Nadji M, et al. Mucinous cystadenocarcinoma of the pancreas: morphologic and immunocytochemical observations. Am J Surg Pathol. 1987;11:11–20
  130. Vehara H, Nakaizumi A, Ishi H, et al. Cytologic examination of pancreatic juice for differential diagnosis of benign and malignant mucin-producing tumors of the pancreas. Cancer. 1994;74:826–833
  131. Hammel P, Voitot H, Vilgrain V, et al. Diagnostic value of CA 72-4 and carcinoembyonic antigen determination in the fluid of pancreatic cystic lesions. Eur J Gastroenterol Hepatol. 1998;10:345–348
  132. Hammel P, Levy P, Voitot H, et al. Preoperative cyst fluid analysis is useful for the differential diagnosis of cystic lesions of the pancreas. Gastroenterology. 1995;108:1230–1235
  133. Sperti C, Pasquali C, Guolo P, et al. Serum tumor markers and cyst fluid analysis are useful for the diagnosis of pancreatic cystic tumors. Cancer. 1996;78:237–243
  134. Sand JA, Hyoty MK, Mattila J, et al. Clinical assessment compared with cyst fluid analysis in the differential diagnosis of cystic lesions of the pancreas. Surgery. 1996;119:275–280
  135. Kubota K, Noie T, Sano K, et al. Impact of intraoperative ultrasonography on surgery for cystic lesions of the pancreas. World J Surg. 1997;21:72–77
  136. Talamini MA, Moesinger R, Yeo CJ, et al. Cystadenomas of the pancreas. Is enucleation an adequate operation. Ann Surg. 1998;227:896–903
  137. Hodgkinson DJ, ReMine WH, Weiland LH. Pancreatic cystadenoma: a clinicopathologic study of 45 cases. Arch Surg. 1978;113:512–519
  138. Iacono C, Bortolasi L, Serio G. Is there a place for central pancreatectomy in pancreatic surgery?. J Gastrointest Surg. 1998;2:509–516
  139. Aranha GV. Central (middle segment) pancreatectomy: a suitable operation for small lesions of the neck of the pancreas. Hepatogastroenterology. 2002;49:1713–1715
  140. Molino D, Perrotti P, Antropoli C, et al. Central segmental pancreatectomy in benign and borderline neoplasms of the pancreatic isthmus and body. Chir Ital. 2001;53:319–325
  141. Kimura W, Fuse A, Hirai I, et al. Spleen-preserving distal pancreatectomy with preservation of the splenic artery and vein for intraductal papillary mucinous tumor (IPMT). Hepatogastroenterology. 2003;50:2242–2245
  142. Lukish JR, Rothstein JH, Petruzziello M, et al. Spleen-preserving pancreatectomy for cystic pancreatic neoplasms. Am Surg. 1999;65:596–599
  143. Wood D, Silberman AW, Heifetz L, et al. Cystadenocarcinoma of the pancreas: neo-adjuvant therapy and CEA monitoring. J Surg Oncol. 1990;43:56–60
  144. Kiely JM, Nakeeb A, Komorowski RA, et al. Cystic pancreatic neoplasms: enucleate or resect?. J Gastrointest Surg. 2003;7:890–897
  145. Jiminez RE, Warshaw AL, Z’graggen K, et al. Sequential accumulation of K-ras mutations and p53 overexpression in the progression of pancreatic mucinous cystic neoplasms to malignancy. Ann Surg. 1999;230:501–511
  146. Sohn TA, Yeo CJ, Cameron JL, et al. Intraductal papillary mucinous neoplasms of the pancreas: an increasingly recognized clinicopathological entity. Ann Surg. 2001;234:313–322
  147. Paye F, Sauvanet A, Terris B, et al. Intraductal papillary mucinous tumors of the pancreas: pancreatic resections guided by preoperative morphological assessment and intraoperative frozen section examination. Surgery. 2000;127:536–544
  148. Cuillerier E, Cellier C, Palazzo L, et al. Outcome after surgical resection of intraductal papillary and mucinous tumors of the pancreas. Am J Gastroenterol. 2000;95:441–445
  149. Falconi M, Salvia R, Bassi C, et al. Clinicopathological features and treatment of intraductal papillary mucinous tumors of the pancreas. Br J Surg. 2001;88:376–381
  150. Maire F, Hammel P, Terris B, Paye F, Scoazec J-Y, Cellier C, et al. Prognosis of malignant intraductal papillary mucinous tumours of the pancreas after surgical resection. Comparison with pancreatic ductal adenocarcinoma. Gut. 2002;51:717–722
  151. Salvia R, Fernandez-del Castillo C, Bassi C, Thayer SP, Falconi M, Mantovani W, et al. Main-duct intraductal papillary mucinous neoplasms of the pancreas: clinical predictors of malignancy and long-term survival following resection. Ann Surg. 2004;239:678–687
  152. Traverso LW. Surgical treatment of intraductal papillary mucinous neoplasms of the pancreas: the aggressive approach. J Gastrointest Surg. 2002;6:662–663
  153. Schachter PP, Avni Y, Gvirz G, et al. The impact of laparoscopy and laparoscopic ultrasound on the management of pancreatic cystic lesions. Arch Surg. 2000;135:260–264
  154. Schchter PP, Shimonov M, Czerniak A. The role of laparoscopy and laparoscopic ultrasound in the diagnosis of cystic lesions of the pancreas. Gastrointest Endosc Clin North Am. 2002;12:759–767
  155. Gagner M, Pomp A. Laparoscopic pancreatic resection: is it worthwhile?. J Gastrointest Surg. 1997;1:20–26
  156. Maruyama M, Kenmochi T, Asano T, et al. Laparoscopic distal pancreatectomy as the total biopsy of the pancreas: tool of minimally invasive surgery. J Hepatobil Pancreat Surg. 2004;11:290–292
  157. Fernandez-Cruz L, Martinez I, Gilabert R, et al. Laparoscopic distal pancreatectomy combined with preservation of the spleen for cystic neoplasms of the pancreas. J Gastrointest Surg. 2004;8:493–501
  158. Baca I, Bokan I. Laparoscopic segmental pancreas resection and pancreatic cystadenoma. Chirurg. 2003;74:961–965
  159. Doi R, Ito D, Fujimoto K, et al. Hand-assisted laparoscopic resection of serous cystadenoma of the pancreas. Surg Endosc. 2003;17:2028–2031
  160. Shimizu S, Tanaka M, Konomi H, et al. Laparoscopic pancreatic surgery: current indications and surgical results. Surg Endosc. 2004;18:402–406
  161. Gagner M, Pomp A, Herrera MF. Early experience with laparoscopic resections of islet cell tumors. Surgery. 1996;120:1051–1054
  162. Wilentz RE, Albores-Saavedra J, Zahurak M, et al. Pathologic examination accurately predicts prognosis in mucinous cystic neoplasms of the pancreas. Am J Surg Pathol. 1999;23:1320–1327
  163. Southern JF, Warshaw AL, Lewandrowski KB. DNA ploidy analysis of mucinous cystic tumors of the pancreas. Correlation of aneuploidy with malignancy and poor prognosis. Cancer. 1996;77:58–62
  164. Obara T, Maguchi H, Saitoh Y, et al. Mucin-producing tumor of the pancreas. Am J Gastroenterol. 1993;88:564–569
  165. Doberstein C, Kirchner R, Gordon L, et al. Cystic neoplasms of the pancreas. Mt Sinai J Med. 1990;57:102–105
  166. Brenin DR, Talamonti MS, Tang EY, et al. Cystic neoplasms of the pancreas. A clinicopathologic study including DNA flow cytometry. Arch Surg. 1995;130:1048–1054
  167. Trede M, Schwall G, Saeger HD. Survival after pancreatoduodenectomy. 118 Consecutive resections without an operative mortality. Ann Surg. 1990;211:447–458
  168. Cameron JL, Pitt HA, Yeo CJ, et al. One hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Ann Surg. 1993;217:430–438
  169. Sarles H, Cambon P, Choux R, et al. Chronic obstructive pancreatitis due to tiny bening tumors obstructing pancreatic ducts. Reports of three cases. Pancreas. 1988;3:232–237

PII: S0305-7372(05)00159-3

doi: 10.1016/j.ctrv.2005.09.001

Cancer Treatment Reviews
Volume 31, Issue 7 , Pages 507-535 , November 2005