Cystic neoplasm of the pancreas is a rare disease accounting for less than 10% to 13% of pancreatic cysts and 1% of patcreatic cancers. It is important to recognize the nature of these tumors for several reasons: they are potenially malignant
except
serous cystadenoma; gross inspection and even biopsy of the cyst wall can be misleading for distinguishing pseudocysts from neoplasm, serous from mucinous, and benign from malignant; they are readily removable and cure is frequently expected even
after
resection of cystadenocarcinoma.
During the 3-year period, we treated 10 patients (8 women, 2 men: mean age 45 yrs) with cystic neoplasm of the pancreas. Including 2 serous cystic adenoma, 4 benign mucinous cystic neoplasms, 1 mucinous cystadenocarcinoma, 2 papillary and solid
cystic
tumor and 1 mucinous ductal ectasia.
Mean tumor size was 8.6cm (1.5 to 16cm) and 1 of 10 tumors was malingant. Computed tomography was useful for detection, but was not reliable for distinguishing benign from malignant.
Endoscopic pancreatography showed no communication with the cystic cavity in 2 of 2 cases cystic neoplasms but opacified the ectatic ducts in J of l case of mucinous ductal ectasia.
The tumor was resected by distal pa createctomy in 7 patients, by proximal resection 2 with no operative deaths.
While asymptomatic serous cystadenoma can be observed safely, in practice it is difficult to determine with certainty that a given lesion is a serous cystadenoma and not one of the other, premalignant or malignant varieties.
We suggest that cystic tumors of the pancreas should, in general, be resected for the relief of symptoms and for treatment of cancer, when given the low risk of resection.
|