Clinicopathological Study of Cystic Lesions of Pancreas at A Tertiary Care Center
Keywords:
cyst, serous cystadenoma, solid papillary pseudotumor, pseudocyst, Whipple’s resection
Abstract
Background: Cystic lesions of pancreas though uncommon are being increasingly identified as a result of developments in imaging techniques. Rapid advances in pancreatic surgeries associated with better patient outcome have led to a variety of pancreatic lesions being increasingly resected and pathologically diagnosed. Newer entities and classification systems have emerged. Methods: This was a hospital based study conducted in the Department of Pathology, Academy of Medical sciences, Pariyaram. In the 91pancreatic resections done over a period of 3 years from 2013-2016, there were 15 cases of cystic pancreatic lesions which formed the subject of the present study. Result: Cystic pancreatic lesions constituted 16.5% of cases (15 cases) of the 91 pancreatic resections done for various reasons. Of the 15 cases, there were 4 non-neoplastic cysts all of which were pancreatic pseudocysts with a M:F ratio of 3:1. There were 11 neoplastic cystic lesions with 4 serous cystadenomas, 3 solid papillary pseudotumors, 2 mucinous cystadenomas and 1 case each of invasive adenocarcinoma in Intraductal Papillary Mucinous Neoplasm (IPMN) and IPMN with low grade dysplasia Except for the one patient with invasive adenocarcinoma in IPMN all others with neoplastic lesions were females. Age of the patients ranged from 14-67 yrs. Conclusion: Cystic tumors of the pancreas are more common in females with the majority of the tumors being benign when compared to ductal adenocarcinomas which are aggressive tumors with higher incidence in males. The possibility of Solid papillary pseudotumor should always be considered in young females presenting with an encapsulated pancreatic mass especially in the tail of pancreas.References
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15. Grutzmann R, Post S, Saeger HD, Niedergethmann M. Intraductal papillary mucinous neoplasia of the pancreas. Dtsch Arztebl Int 2011;108:788-794.
16. Jana T, Shroff J, Bhutani M S. Pancreatic cystic neoplasms:Reviwew of current knowledge, diagnostic challenges and management options.J Carcinog 2015;14.3.
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18. Tanaka M, Castillo CF, Adsay V, Chari S, Falconi M, Jang J-Y et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas.Pancreatology2012;12:183-197.
19. Castellano-Megias VM, Ibarrola-de Andres C, Lopez-Alonso G, Colina-Ruizdelgado F. Pathological features and diagnosis of intraductal papillary mucinous neoplasm of the pancreas.World J Gastrointest Oncol 2014;6:311-324.
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21. Patil TB, Shrikhande SV, Kanhere HA, Saoji RR, Ramadwar MR, Shukla PJ. Solid pseudopapillary neoplasm of the pancreas: a single institution experience of 14 cases. HPB 2006; 8: 148-150.
22. Ozguven BY, Tuncel D, Polat N, Sakiz D, Kabukcuoglu F, Koksal H et al.Solid-pseudopapillary neoplasm of the pancreas: Clinicopathologic and immunohistochemical analysis of nine cases. I J P M 2015 ;58 :292-295.
23. Chatelain D, Paye F, Mourra N, Scoazee J-Y, Baudrimont M, Parc R et al.Unilocular Acinar Cell Cystadenoma of the Pancreas-An Unusual Acinar Cell Tumor.Am J Clin Pathol 2002;118:211-214.
2. Odze RD, Goldbum JR. Surgical pathology of GI tract, liver, biliary tract and pancreas(3rd ed) Elseiver Saunders;2015:1093-1108.
3. Adsay NV. Cystic lesions of Pancreas. Modern Pathology 2007;20:S71-S93.
4. Vassos N, Agaimy A, Klein P, Hohenberger W, Croner RS. Solid-pseudopapillary neoplasm (SPN) of the pancreas: Case series and literature review on an enigmatic entity. Int J Clin Exp Pathol 2013;6:1051-9.
5. Hutchins G F, Draganov P V. Cystic neoplasms of the pancreas: A diagnostic challenge. World J Gastroenterol 2009 ; 15: 48-54.
6. Kim YS, Cho JH. Rare Non-neoplastic cysts of pancreas. Clin Endosc 2015;48:31-38.
7. Basturk O, Coban I, Adsay NV. Pancreatic cyst-Pathologic classification, Differential diagnosis and clinical implications. Arch Pathol Lab Med 2009;133:423-438.
8. Brugge WR. Diagnosis and management of cystic lesions of the pancreas. J Gastrointest Oncol 2015;6:375-388.
9. Jacob S, Rawat P, Mark RP .Serous microcystic adenoma (glycogen rich cystadenoma) of the pancreas. IJPM 2010;53:106-108.
10. Omeroglu A, Paner G P, Ciesla MC, Hartman G. Serous Microcystic Adenoma of the Pancreas. Arch Pathol Lab Med 2001; 125: 1613-1614.
11. Reid MD, Choi H, Balci S, Akkas G, Adsay V.Serous cystic neoplasms of the pancreas: Clinicopahologic and molecular characteristics.Seminars in Diag Pathol 2014;31:475-483.
12. Dyke TJV, Johlin FC, Bellizzi AM, Howe JR. Serous Cystadenocarcinoma of the Pancreas: Clinical Features and Management of a Rare Tumor. Dig Surg 2016;33:240–248.
13. Sarr MG, Carpenter HA, Prabhakar LW, Orchard TF, Hughes S,van Heerden JA 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 Of Surgery2000;231: 205–212.
14. Crippa S, Salvia R, Warshaw AL, Domínguez I, Bass C, Falconi M et al.Mucinous Cystic Neoplasm of the Pancreas is Not an Aggressive Entity:Lessons From 163 Resected Patients. Ann Surg 2008 ; 247: 571–579.
15. Grutzmann R, Post S, Saeger HD, Niedergethmann M. Intraductal papillary mucinous neoplasia of the pancreas. Dtsch Arztebl Int 2011;108:788-794.
16. Jana T, Shroff J, Bhutani M S. Pancreatic cystic neoplasms:Reviwew of current knowledge, diagnostic challenges and management options.J Carcinog 2015;14.3.
17. Machado NO, Al Qadhi H, Al Wahibi K. Intraductal Papillary Mucinous Neoplasm of Pancreas.N Am J Med Sci 2015;7:160-175.
18. Tanaka M, Castillo CF, Adsay V, Chari S, Falconi M, Jang J-Y et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas.Pancreatology2012;12:183-197.
19. Castellano-Megias VM, Ibarrola-de Andres C, Lopez-Alonso G, Colina-Ruizdelgado F. Pathological features and diagnosis of intraductal papillary mucinous neoplasm of the pancreas.World J Gastrointest Oncol 2014;6:311-324.
20. Schmidt CM, White P, Waters JA, Yiannoutsos C, Cummings OW, Baker MS . Intraductal papillary mucinous neoplasms: predictors of malignant and invasive pathology. Ann Surg. 2007; 246:644–651.
21. Patil TB, Shrikhande SV, Kanhere HA, Saoji RR, Ramadwar MR, Shukla PJ. Solid pseudopapillary neoplasm of the pancreas: a single institution experience of 14 cases. HPB 2006; 8: 148-150.
22. Ozguven BY, Tuncel D, Polat N, Sakiz D, Kabukcuoglu F, Koksal H et al.Solid-pseudopapillary neoplasm of the pancreas: Clinicopathologic and immunohistochemical analysis of nine cases. I J P M 2015 ;58 :292-295.
23. Chatelain D, Paye F, Mourra N, Scoazee J-Y, Baudrimont M, Parc R et al.Unilocular Acinar Cell Cystadenoma of the Pancreas-An Unusual Acinar Cell Tumor.Am J Clin Pathol 2002;118:211-214.
Published
2018-08-23
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