Experience-based surgical approach to pancreatic mucinous cystic neoplasms with ovarian-type stroma

Kang,Chang  Moo; Matsushita,Akira; Hwang,Ho  Kyoung; Matsuda,Yoko; Kim,Hyunki; Nakamura,Yoshiharu; Lee,Woo  Jung

doi:10.3892/ol.2017.7627

Experience-based surgical approach to pancreatic mucinous cystic neoplasms with ovarian-type stroma

Authors:
- Chang Moo Kang
- Akira Matsushita
- Ho Kyoung Hwang
- Yoko Matsuda
- Hyunki Kim
- Yoshiharu Nakamura
- Woo Jung Lee
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Affiliations: Department of Surgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea, Department of Gastrointestinal and Hepato‑Biliary‑Pancreatic Surgery, Nippon Medical School, Tokyo 113‑8603, Japan, Department of Integrative Oncological Pathology, Nippon Medical School, Tokyo 113‑8603, Japan, Department of Pathology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
Published online on: December 14, 2017 https://doi.org/10.3892/ol.2017.7627
Pages: 2451-2458

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Abstract

The present study aimed to elucidate the clinicopathological characteristics of resected mucinous cystic neoplasm (MCN) with ovarian‑type stroma and identify a surgical approach for MCN treatment, on the basis of Republic of Korean (Yonsei University College of Medicine, Seoul, South Korea) and Japanese (Nippon Medical School, Tokyo, Japan) bi‑institutional collaboration. The present study retrospectively reviewed 55 MCNs with ovarian‑type stroma using pathological re‑examination. Clinicopathological features and preoperative clinical parameters were evaluated to predict malignant alterations in MCNs. The proportion of surgically treated MCNs has recently been increasing. All patients included in the present study were female, with a mean age of 47.9±13.3 years. Mural nodules were noted in 8 patients (14.5%) and the mean cyst size was 6.1±4.2 cm. A total of 9 patients (16.4%) were identified to exhibit non‑invasive mucinous cystadenocarcinoma. The number of patients with small tumors (R2=‑0.079, P=0.038) and asymptomatic pancreatic MCNs (P=0.022) was significantly increased (P<0.05), which resulted in the more frequent application of minimally invasive surgery (P<0.001). During the follow‑up period (mean, 51.6 months; range, 1.1‑242.8 months), no recurrence or tumor‑associated mortality was identified. The presence of mural nodules (P=0.002) and a tumor size ≥4.5 cm (P=0.027) were identified as potential clinical parameters for predicting malignant transformation. The significance of mural nodules in predicting malignant transformation was increased in large MCNs (≥4.5 cm) of the pancreas compared with small MCNs (<4.5 cm) (P=0.002). Overall, non‑invasive pancreatic MCNs are not aggressive, and minimally invasive pancreatectomy may be an effective approach for suitable patients.

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