From the Guidelines
Mucinous cystadenoma should be managed with a conservative approach if asymptomatic and measuring <40 mm without an enhancing nodule, as recommended by the European evidence-based guidelines on pancreatic cystic neoplasms 1. The management of mucinous cystadenoma, a type of pancreatic cystic neoplasm, has been outlined in recent guidelines.
Key Considerations
- The European evidence-based guidelines on pancreatic cystic neoplasms, published in 2018, provide recommendations for the management of mucinous cystic neoplasms (MCN) and intraductal papillary mucinous neoplasms (IPMN) 1.
- A conservative approach is recommended for asymptomatic MCN and IPMN measuring <40 mm without an enhancing nodule.
- Relative indications for surgery in IPMN include a main pancreatic duct (MPD) diameter between 5 and 9.9 mm or a cyst diameter ≥40 mm.
- Absolute indications for surgery in IPMN, due to the high-risk of malignant transformation, include jaundice, an enhancing mural nodule >5 mm, and MPD diameter >10 mm.
Diagnostic Approach
- Diagnosis typically involves imaging studies (ultrasound, CT, or MRI) followed by histopathological confirmation after surgical removal.
- The American Gastroenterological Association (AGA) suggests that patients with pancreatic cysts <3 cm without a solid component or a dilated pancreatic duct undergo MRI for surveillance in 1 year and then every 2 years for a total of 5 years if there is no change in size or characteristics 1.
Treatment and Follow-up
- Complete surgical excision is recommended for mucinous cystadenomas that are symptomatic or have high-risk features, as they have malignant potential if left untreated.
- For ovarian mucinous cystadenomas, treatment usually involves oophorectomy or cystectomy depending on the patient's age and desire for fertility preservation.
- Pancreatic mucinous cystadenomas require surgical resection, typically through distal pancreatectomy for tail/body lesions or pancreaticoduodenectomy (Whipple procedure) for head lesions.
- Long-term follow-up is recommended as there is a small risk of malignant transformation, particularly in pancreatic lesions. Patients should be monitored with periodic imaging studies, typically annually for several years after resection.
From the Research
Definition and Prevalence of Mucinous Cystadenoma
- Mucinous cystadenoma is the second most common epithelial tumor of the ovary, constituting about 8-10% of all ovarian tumors 2.
- Benign mucinous cystadenomas account for 15% of all ovarian neoplasms and up to 80% of all mucinous tumors 3.
Management and Treatment
- Laparoscopy has become an accepted method of management for ovarian cysts, and its role is expanding as large benign adnexal masses can be managed safely and effectively 3, 4.
- In young patients, management is challenging, especially in the case of recurrence, and follow-up is very important 2, 3.
- Transvaginal ultrasound seems to be currently the most effective diagnostic tool for the follow-up of young patients treated with cystectomy for benign mucinous cystadenomas 2.
- Total hysterectomy and bilateral salpingo-oophorectomy is recommended after completing family size or reaching age of 35 for fear of progression or incompliance 2.
Clinical Characteristics and Outcomes
- Mucinous cystadenoma can grow to be extremely large, posing unique surgical and anesthetic challenges 4, 5.
- Surgical resection is the primary treatment modality for mucinous cystadenoma, and a multidisciplinary approach optimizes patient outcomes 6, 5.
- The rate of major complications and clinically relevant pancreatic fistula can be higher in patients with mucinous cystadenocarcinoma compared to those with mucinous cystadenoma 6.