Pancreatic mucinous cystic neoplasm


Pancreatic mucinous cystic neoplasm is a type of cystic lesion that occurs in the pancreas. Amongst individuals undergoing surgical resection of a pancreatic cyst, about 23 percent were mucinous cystic neoplasms. These lesions are benign, though there is a high rate of progression to cancer. As such, surgery should be pursued when feasible. The rate of malignancy present in MCN is between 11 and 38 percent. If resection is performed before invasive malignancy develops, prognosis is excellent. The extent of invasion is the single most important prognostic factor in predicting survival.

Pathology

Factors that predict malignancy include loculated appearance, mural nodules, papillary projections, p53 immunoreactivity, and loss of ovarian-like stroma.

Management

Where possible, surgical resection of mucinous cystic neoplasms is preferable. In individuals unable to undergo surgery, there may be a role for endoscopic ultrasound guided ablation with alcohol lavage with paclitaxel injection. EUS guided therapy has been performed successfully, though more data is necessary, particularly prospective study. An EUS-guided approach appears more effective with smaller sized MCNs.

Epidemiology

MCNs are much more common in women. A study in 2012 found that amongst individuals undergoing surgical resection of a pancreatic cyst, about 23 percent were mucinous cystic neoplasms. The rate of malignancy present in MCN is between 11 and 38 percent. Malignancy is more often present in older individuals.