CYSTIC NEOPLASMS OF THE PANCREAS - A CLINICOPATHOLOGICAL STUDY, INCLUDING DNA FLOW-CYTOMETRY

Objective: To review the classification, clinical behavior, and approp riate therapy for cystic neoplasms of the pancreas. We examined patien t demographics, clinical parameters, preoperative imaging modalities, histologic findings, and tumor DNA content to determine which best pre dict outcome. Design: Case series and survey of pathologic specimens. Setting: Tertiary care center. Patients: Twenty-two patients with cyst ic neoplasms of the pancreas treated at affiliates of Northwestern Uni versity Medical School, Chicago, Ill. Main Outcome Measures: Predictiv e value of preoperative testing, tumor DNA content, patient survival. Results: In 20 patients undergoing computed tomographic scan, the tumo r was visualized in every case. All other imaging studies evaluated we re less likely to demonstrate the lesion. Eight of 10 patients with se rous cystadenomas were alive with no evidence of disease at the time o f this report; one patient was alive with local recurrence, and a seco nd patient had died of unrelated causes. hll patients with mucinous cy stadenomas were alive with no evidence of disease. Three of seven pati ents with cystadenocarcinomas had aneuploid, high S-phase tumors, and one had a diploid, high S-phase tumor; all four died (mean survival, 4 .8 months). Two patients with cystadenocarcinomas had diploid, low S-p hase tumors; both were longterm survivors but died of their disease at 8.6 and 9.3 years. Conclusions: (1) Computed tomographic scan is the most valuable diagnostic imaging study for preoperative evaluation of these patients. (2) Precise preoperative determination of tumor type i s not possible. (3) DNA flow cytometry may help identify patients with aggressive tumors who may benefit from adjuvant chemoradiation.