Mucinous cystic tumors of the pancreas - Clinicopathological features, prognosis, and relationship to other mucinous cystic tumors

The clinicopathological features of 56 patients with mucinous cystic tumors (MCTs) of the pancreas were studied. Particular attention was paid to the prognosis of MCTs and the relationship to their ovarian, hepatic, and retro peritoneal counterparts. To distinguish MCTs from pancreatic intraductal pa pillary-mucinous tumors, MCTs were defined as tumors lacking communication with the duct system and containing mucin-producing epithelium, usually sup ported by ovarian-like stroma. All 56 tumors occurred in women (mean age 48 .2 years) and were preferentially (93%) located in the body and tail of the pancreas. In accordance with the WHO classification, MCTs were divided int o adenomas (n = 22), borderline tumors (n = 12), and noninvasive and invasi ve carcinomas (n = 22). Survival analysis revealed the extent of invasion t o be the most significant prognostic factor (p < 0.0001). Malignancy correl ated with multilocularity and presence of papillary projections or mural no dules, loss of ovarian-like stroma, and p53 immunoreactivity. Stromal lutei nization with expression of tyrosine hydroxylase, calretinin, or alpha inhi bin was found in 66% of the cases. We conclude that the biologic behavior o f MCTs is predictable on the basis of the extent of invasion. The similarit ies (i.e. gender, morphology, stromal luteinization) between pancreatic MCT and its ovarian, hepatobiliary, and retroperitoneal counterparts suggest a common pathway for their development.