Risk of malignancy in serous cystic neoplasms of the pancreas.
BACKGROUND
In contrast to mucinous cystic neoplasms of the pancreas, which are known to have considerable malignant potential, the serous variant is generally thought to be benign. There are, however, several reports of malignancy in serous cystic neoplasms of the pancreas.


OBJECTIVE
To assess the risk of malignancy of serous cystic tumors of the pancreas and to investigate specific clinical and histological features.


METHODS
Clinical and pathological characteristics of benign and malignant serous cystic neoplasms of the pancreas were investigated by a review of the literature and documented by a case of a serous cystadenocarcinoma and immunohistochemical analysis of a series of serous cystadenomas. Reviewing the literature prevalence, age and sex distribution of serous cystic neoplasms were analyzed.


RESULTS
The prevalence of cancer among serous cystic neoplasms reported since 1989 was 3%. Serous cystadenoma of the pancreas present at an earlier age (61 years) than serous cystadenocarcinoma (66 years; p = 0.056) and are symptomatic in the majority of patients. Pathological examination of the primary tumor was not able to distinguish cystadenoma from cystadenocarcinoma in 38% of cases. In 25% the diagnosis of cancer was established only after growth of metachronous metastases. In the present case, nuclear atypia, papillary structures, proliferation marker Ki-67 and p53 protein were increased in the primary tumor and/or metachronous metastasis.


CONCLUSIONS
Serous cystic neoplasms of the pancreas do have malignant potential with a risk of malignancy of 3% and should be surgically treated if the operative risk is acceptable. Routine analysis of genetic and proliferation markers may improve diagnosis of malignancy in these tumors.
Strobel
Oliver
O
Department of General Surgery, University of Heidelberg, Heidelberg, Germany.
Z'graggen
Kaspar
K
Schmitz-Winnenthal
Friedrich H
FH
Friess
Helmut
H
Kappeler
Andreas
A
Zimmermann
Arthur
A
Uhl
Waldemar
W
Büchler
Markus W
MW
D018284:Cystadenocarcinoma, Serous / Q000473:pathology*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000473:pathology*; D015995:Prevalence; D018570:Risk Assessment