From the Guidelines
Pancreatic mucinous cystadenoma (MCN) should be treated with a standard oncologic resection, such as distal pancreatectomy with lymph node dissection and splenectomy, for any MCN with imaging features indicating high-grade dysplasia or cancer. This approach is based on the European evidence-based guidelines on pancreatic cystic neoplasms, which recommend a standard oncologic resection to avoid incomplete treatment of invasive carcinoma 1. The guidelines suggest that MCN without suspect features and with a low risk of malignancy can be treated with a non-oncological resection, such as distal pancreatectomy with splenic preservation with or without preservation of splenic vessels (PSP) 1. However, a PSP may only be considered in selected patients to decrease the long-term risk of diabetes, provided the anatomical location is favorable 1.
Key considerations in the management of MCN include:
- The risk of malignant transformation, which is estimated to be around 10-15% at diagnosis
- The importance of complete surgical resection to prevent recurrence and improve prognosis
- The need for regular follow-up imaging to monitor for potential recurrence
- The potential benefits and risks of different surgical approaches, including distal pancreatectomy and pancreaticoduodenectomy (Whipple procedure)
In terms of diagnosis, MCN is typically characterized by mucin-producing columnar epithelium lining the cyst, and diagnosis involves a combination of imaging studies (CT, MRI, endoscopic ultrasound) and analysis of cyst fluid for CEA levels, amylase, and cytology. Patients may present with vague abdominal pain, nausea, or may be asymptomatic with the lesion discovered incidentally on imaging performed for other reasons. Overall, the management of MCN requires a multidisciplinary approach, taking into account the individual patient's risk factors, imaging features, and overall health status 1.
From the Research
Characteristics of Pancreatic Mucinous Cystadenoma
- Pancreatic mucinous cystadenoma (MCA) occurs almost exclusively in perimenopausal women and represents between 10% and 45% of cystic neoplasm of the pancreas, being considered a premalignant lesion 2.
- The median age of patients with MCA is 47 years, with a female∕male gender ratio of 14.5∕1 2.
- Most patients (90.3%) with MCA are symptomatic, with non-specific abdominal pain being the most common clinical manifestation (58.06%), followed by fatigue and vomiting 2.
Diagnosis and Treatment
- Multi-detector computed tomography (MDCT) scan, endoscopic ultrasound (EUS), and magnetic resonance imaging (MRI)/magnetic resonance cholangiopancreatography (MRCP) are useful in the differential diagnosis with other pancreatic fluid collections and treatment 2.
- Oncological surgical resections are recommended, with histopathological examination establishing the final diagnosis 2.
- Surgical resection is the primary treatment modality for MCA, with minimally invasive surgery being a viable option 3, 4.
- Hand-assisted laparoscopic technique is a useful approach for MCA resection, offering the advantages of a minimally invasive approach while maintaining similar outcomes to open procedures 4.
Prognosis and Complications
- Postoperative complications occurred in 34.48% of patients, with pancreatic fistula being the most common complication 2.
- The rate of major complications was 5.7% and that of clinically relevant pancreatic fistula was 8.6% in the MCA group 3.
- Tumor size, age, and serum levels of tumor markers such as carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9, and CA12-5 may contribute to the management of patients with MCA 3.