Nature and management of pancreatic mucinous cystic neoplasm (MCN): A systematic review of the literature |
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| Affiliation: | 1. Karolinska Institutet, Stockholm, Sweden;2. Institute for Liver and Digestive Health, University College London, UK;3. Southampton University Hospital, UK;4. Miguel Servet University Hospital, Zaragoza, Spain;5. Radboud University Medical Center Nijmegen, Netherlands;6. Tampere University Hospital, Tampere, Finland;7. Ciudad Real University Hospital, Spain;1. Departments of Medicine (Gastroenterology) and Radiology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, United States;2. Mayo Clinic, United States;3. MD Anderson Cancer Center, United States;4. Beth Israel Deaconess Medical Center, United States;5. Dana Farber Cancer Institute, United States;6. University of California, Los Angeles, United States;1. Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA;2. Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA;3. Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA;1. Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan;2. Division of Diagnostic Pathology, Graduate School of Medicine, Kobe University, Japan;3. Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Japan;4. Department of Pathology, Brigham and Women''s Hospital and Harvard Medical School, USA;5. Department of Medical Oncology, Dana-Farber Cancer Institute, USA;6. Department of Epidemiology, Harvard School of Public Health, USA;1. Department of Surgery, Massachusetts General Hospital, Boston, MA;2. Department of Surgery, Harvard Medical School, Boston, MA;3. Department of Pathology, Massachusetts General Hospital, Boston, MA;4. Department of Radiology, Massachusetts General Hospital, Boston, MA;5. Department of Radiology, Harvard Medical School, Boston, MA;6. Division of Gastroenterology, Massachusetts General Hospital, Boston, MA;7. Department of Internal Medicine, Harvard Medical School, Boston, MA;8. Department of Pathology, Harvard Medical School, Boston, MA |
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| Abstract: | BackgroundThe current management of pancreatic mucinous cystic neoplasms (MCN) is defined by the consensus European, International Association of Pancreatology and American College of Gastroenterology guidelines. However, the criterion for surgical resection remains uncertain and differs between these guidelines. Therefore through this systematic review of the existing literature we aimed to better define the natural history and prognosis of these lesions, in order to clarify recommendations for future management.MethodsA systematic literature search was performed (PubMed, EMBASE, Cochrane Library) for studies published in the English language between 1970 and 2015.ResultsMCNs occur almost exclusively in women (female:male 20:1) and are mainly located in the pancreatic body or tail (93–95%). They are usually found incidentally at the age of 40–60 years. Cross-sectional imaging and endoscopic ultrasound are the most frequently used diagnostic tools, but often it is impossible to differentiate MCNs from branch duct intraductal papillary mucinous neoplasms (BD-IPMN) or oligocystic serous adenomas pre-operatively. In resected MCNs, 0–34% are malignant, but in those less than 4 cm only 0.03% were associated with invasive adenocarcinoma. No surgically resected benign MCNs were associated with a synchronous lesion or recurrence; therefore further follow-up is not required after resection. Five-year survival after surgical resection of a malignant MCN is approximately 60%.ConclusionsCompared to other pancreatic tumors, MCNs have a low aggressive behavior, with exceptionally low rates of malignant transformation when less than 4 cm in size, are asymptomatic and lack worrisome features on pre-operative imaging. This differs significantly from the natural history of small BD-IPMNs, supporting the need to differentiate mucinous cyst subtypes pre-operatively, where possible. The findings support the recommendations from the recent European Consensus Guidelines, for the more conservative management of MCNs. |
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| Keywords: | Mucinous cystic neoplasm MCN Pancreatic cystic neoplasm Pancreatic cystic tumor |
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