Management of Cystic Neoplasms of the Pancreas
The classification and management of cystic neoplasms of the pancreas has changed dramatically over the past 30 years. The pathologic differential diagnosis of this heterogeneous group of lesions began in 1978 with landmark publications by Compagno and Oe
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Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1126
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Serous Cystadenomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1126
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Mucinous Cystic Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1128
4 Intraductal Papillary Mucinous Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1130 4.1 Main-Duct IPMN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1130 4.2 Branch Duct IPMN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1133 5
Benign Cysts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1135
J. P. Neoptolemos, R. Urrutia, J. L. Abbruzzese, M. W. Bu¨chler (eds.), Pancreatic Cancer, DOI 10.1007/978-0-387-77498-5_47, # Springer Science+Business Media, LLC 2010
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Management of Cystic Neoplasms
Abstract: The classification and management of cystic neoplasms of the pancreas has changed dramatically over the past 30 years. The pathologic differential diagnosis of this heterogeneous group of lesions began in 1978 with landmark publications by Compagno and Oertel [1,2]. Serous cystic lesions, mucinous cystic lesions and intraductal papillary mucinous neoplasms (IPMNs) together comprise about 90% of cystic neoplasms of the pancreas. Serous cystadenomas are indolent slow-growing tumors which are firm, well-circumscribed, and multinodular. Mucinous cystic neoplasms (MCNs) have an ovarian-like stromal layer and encompass a wide spectrum from benign lesions with malignant potential to aggressive carcinomas. These lesions demonstrate histologic heterogeneity, with benign-appearing and malignant epithelia in almost every lesion. One of the most common lesions identified in the pancreas is the IPMN. Of the two variants the main duct IPMNs are more aggressive than the branch duct IPMNs. Currently, incidentally discovered cysts comprise up to 71% of cystic lesions identified. The management of cystic lesions has evolved from resection of all lesions, to selective resection or close follow-up with imaging, due to the improved understanding of the natural history of these lesions. This chapter will address the surgical management of serous cystic lesions, mucinous cystic lesions and IPMNs.
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Introduction
The classification and management of cystic neoplasms of the pancreas has changed dramatically over the past 30 years. Initially all cystic neoplasms were crudely divided into cystadenomas and cystadencarcinomas. The pathologic differential diagnosis of this heterogeneous group of lesions began in 1978 with landmark publications by Compagno and Oertel [1,2]. Improved
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