review of literature on clinical pancreatology - The Pancreapedia

size >1.5 cm (odds ratio 2.4), and high CEA (odds ratio 5.3). In white patients >50 years oldpresenting with weight loss and cyst size >1.5 cm, the likelihood <strong>of</strong> malignancy was nearlysixfold greater than in those patients who had none <strong>of</strong> these factors (odds ratio 5.8, 95 %confidence interval 2.1 to 16.1). It was concluded that risk factors other than cyst size areimportant for determination <strong>of</strong> malignancy in pancreatic cysts. Exceptionally high cyst fluidCEA levels and certain patient-related factors may help to better predict cyst malignancy andthe need for surgical treatment [572].Neoplastic changes represent an important part <strong>of</strong> cystic deposits in pancreas. It ismorphologically non-homogenous group <strong>of</strong> neoplasms with different occurrence dependingon sex and age, different localization and different biologic properties. Together 13 patientswith histologically proved cystic neoplasm <strong>of</strong> pancreas underwent surgery during the period<strong>of</strong> ten years from 1997 to 2007. They represent 6 percent <strong>of</strong> all patients operated forpancreatic tumor (213 patients). Women (9 patients) represented more than two thirds <strong>of</strong> alloperated patients and deposits were more <strong>of</strong>ten localized in the head <strong>of</strong> pancreas (8). Themost frequent operation was partial duodenopancreatectomy (7) and most frequentlycystadenocarcinoma was identified histologically (5 times). Median survival <strong>of</strong> these patientsis 54 months. Left sided resection, done in 5 cases, identified benign tumor in all patients; norecurrence was found in 2 years follow-up. It wasconcluded that cystic neoplasms localizedin the pancreatic head are more frequent in men than in women and predominantlymalignant, on the contrary localization in the tail <strong>of</strong> pancreas is particularly in younger womenlinked with benign tumor [573].Cystic lesions <strong>of</strong> the pancreas are being recognized with increasing frequency and havebecome a more common finding in clinical practice because <strong>of</strong> the widespread use <strong>of</strong>advanced imaging modalities and the sharp drop in the mortality rate <strong>of</strong> pancreatic surgery.Consequently, in the past 2 decades, the nature <strong>of</strong> many cystic tumors in this organ hasbeen better characterized, and significant developments have taken place in theclassification and in our understanding <strong>of</strong> pancreatic cystic lesions. In contrast to solidtumors, most <strong>of</strong> which are invasive ductal adenocarcinomas with dismal prognosis, cysticlesions <strong>of</strong> the pancreas are <strong>of</strong>ten either benign or low-grade indolent neoplasia. However,those that are mucinous, namely, intraductal papillary mucinous neoplasms and mucinouscystic neoplasms, constitute an important category because they have well-establishedmalignant potential, representing an adenoma-carcinoma sequence. Those that arenonmucinous such as serous tumors, congenital cysts, lymphoepithelial cysts, and squamoidcyst <strong>of</strong> pancreatic ducts have no malignant potential. Only rare nonmucinous cystic tumorsthat occur as a result <strong>of</strong> degenerative/necrotic changes in otherwise solid neoplasia, such ascystic ductal adenocarcinomas, cystic pancreatic endocrine neoplasia, and solidpseudopapillaryneoplasm, are also malignant and have variable degrees <strong>of</strong> aggressiveness[574].Intraductal papillary mucinous neoplasm (IPMN)Intraductal papillary mucinous tumours (IPMT) were described as a distinct entity in I982.The extent <strong>of</strong> surgical resection for this disease remains controversial. Twelve patients with adiagnosis <strong>of</strong> IPMT were included in the present retrospective study. Ten out <strong>of</strong> twelvepatients had symptoms suggesting chronic pancreatitis. Two patients were not operated ondue to biopsy-verified metastases in the liver. Nine patients were treated with a totalpancreatectomy and one with a pancreaticoduodenectomy. In the ten patients operated onfor IPMT, histological examination showed eight non-invasive- and two invasive carcinomas.In six cases, multifocal extensive intraductal changes were found, affecting either most <strong>of</strong> orthe whole pancreas. There was no perioperative mortality. Six patients were alive at followupwithout recurrence and four patients were dead, two <strong>of</strong> them with recurrence [575].