Cystic neoplasms of the pancreas. A clinicopathologic study, including DNA flow cytometry.
OBJECTIVE
To review the classification, clinical behavior, and appropriate therapy for cystic neoplasms of the pancreas. We examined patient demographics, clinical parameters, preoperative imaging modalities, histologic findings, and tumor DNA content to determine which best predict outcome.


METHODS
Case series and survey of pathologic specimens.


METHODS
Tertiary care center.


METHODS
Twenty-two patients with cystic neoplasms of the pancreas treated at affiliates of Northwestern University Medical School, Chicago, Ill.


METHODS
Predictive value of preoperative testing, tumor DNA content, patient survival.


RESULTS
In 20 patients undergoing computed tomographic scan, the tumor was visualized in every case. All other imaging studies evaluated were less likely to demonstrate the lesion. Eight of 10 patients with serous cystadenomas were alive with no evidence of disease at the time of this report; one patient was alive with local recurrence, and a second patient had died of unrelated causes. All patients with mucinous cystadenomas were alive with no evidence of disease. Three of seven patients with cystadenocarcinomas had aneuploid, high S-phase tumors, and one had a diploid, high S-phase tumor; all four died (mean survival, 4.8 months). Two patients with cystadenocarcinomas had diploid, low S-phase tumors; both were long-term survivors but died of their disease at 8.6 and 9.3 years.


CONCLUSIONS
(1) Computed tomographic scan is the most valuable diagnostic imaging study for preoperative evaluation of these patients. (2) Precise preoperative determination of tumor type is not possible. (3) DNA flow cytometry may help identify patients with aggressive tumors who may benefit from adjuvant chemoradiation.
Brenin
D R
DR
Department of Surgery, Northwestern University Medical School, Chicago, IL, USA.
Talamonti
M S
MS
Yang
E Y
EY
Sener
S F
SF
Haines
G K
GK
Joehl
R J
RJ
Nahrwold
D L
DL
D000206:Actuarial Analysis; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003536:Cystadenocarcinoma / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D018291:Cystadenoma, Mucinous / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D018293:Cystadenoma, Serous / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D004273:DNA, Neoplasm / Q000032:analysis*; D005260:Female; D005434:Flow Cytometry; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000401:mortality / Q000601:surgery; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016196:S Phase; D016019:Survival Analysis
D004273:DNA, Neoplasm