2 TYPES OF MUCIN-PRODUCING CYSTIC TUMORS OF THE PANCREAS - DIAGNOSIS AND TREATMENT

Background. This study focuses on clinicopathologic, imaging, and prog nostic differences between two types of mucin-producing cystic tumors of the pancreas, with the aim of appropriate management of these tumor s. Methods. Forty-six patients with mucin-producing cystic tumors unde rwent operation. The types of tumors were as follows: mucinous cystic neoplasm, adenoma (6) and adenocarcinoma (12); intraductal papillary t umor; adenoma (10) and adenocarcinoma (18). Results. Gender, age, symp toms, signs, tumor location and size, and the presence or absence of c ommunication with the pancreatic duct differed between the two types. Mucinous cystadenocarcinomas showed deep invasion more often. than int raductal papillary adenocarcinomas. Lymph node involvement was seen in 58% of mucinous cystadenocarcinomas but in only 22% of intraductal pa pillary adenocarcinomas. Tumors with mural nodules tended to show deep invasion and nodal metastasis. All four intraductal papillary tumors smaller than 3 cm without mural nodules were adenomas. Imaging studies allowed accurate differentiation between the two types but not betwee n adenomas and adenocarcinomas. Five-year survival rates for patients with adenomas, mucinous cystadenocarcinomas, and intraductal papillary adenocarcinomas were 100%, 33%, and 81%, respectively. Conclusions. M ucinous cystic neoplasm necessitates complete tumor excision with wide dissection. of lymph nodes including paraaortic nodes. Intraductal pa pillary tumor requires only peripancreatic node dissection; for tumors smaller than 3 cm without mural modules, node dissection may be unnec essary.