Prognosis of Minimally Invasive Adenocarcinoma Arising in Mucinous Cystic Neoplasms of the Pancreas.
Gloria H Lewis, Huamin Wang, William Fisher, Richard Schulick, Christopher Wolfgang, John L Cameron, Ralph H Hruban. The Johns Hopkins Medical Institutions, Baltimore, MD; The University of Texas M.D. Anderson Cancer Center, Houston; Baylor College of Medicine, Houston, TX
Background: While patients with surgically resected non-invasive mucinous cystic neoplasms (MCN) of the pancreas are cured, the behavior of surgically resected minimally invasive adenocarcinoma arising in MCN is not well-established. We report the follow-up on 11 surgically resected MCN with minimal stromal invasion.
Design: Eleven surgically resected MCN with minimal stromal invasion, defined as unifocal or multifocal microscopic invasive adenocarcinoma into the ovarian stroma without invasion through the capsule into the adjacent pancreatic parenchyma, were identified in the files of our three institutions. Pathological findings were correlated with patient demographics, type of surgery, and long-term follow-up.
Results: Our study included ten females and 1 male ranging in age from 38-66 years (mean 52.6 years). The MCN ranged in size from 3.5-16 cm (mean 9.8 cm) and were all located in the body/tail of the pancreas. Seven cases had unifocal invasion and 4 cases had multifocal invasion. Multifocal invasion was identified in 2 of 4 cases in which the tumors were entirely submitted for histological examination and 2 of 7 cases in which the tumor was not completely submitted. Lymph nodes were negative in all cases. No lymphovascular invasion was present in any cases. The patients were followed for 19-148 months (mean 58.3 months). During the follow-up, only one of the 11 patients had recurrence at 36 months after resection of a MCN with unifocal invasive adenocarcinoma. The recurrent tumor was identified by CT scan and was surgically unresectable. The patient died secondary to complications from the recurrent tumor at 41 months after resection. Upon review, only 5 sections from the tumor, which measured 5.0 cm, were submitted for histological examination in this case; thus, more extensive invasion could not be excluded.
Conclusions: Surgically resected MCN with minimal stromal invasion have an excellent prognosis. None of the completely examined neoplasms with minimal invasion recurred. The single case in this study which recurred was not completely sampled, possibly leaving areas with more extensive invasion unidentified. Our study demonstrates that the majority of patients with minimally invasive adenocarcinoma arising in MCN are cured by surgery, particularly if the neoplasms are completely examined histologically.
Monday, February 28, 2011 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 94, Monday Morning