title: The diagnosis of pancreatic mucinous cystic neoplasm and associated adenocarcinoma in males: An eight-institution study of 349 patients over 15 years.
abstract: BACKGROUND
  Per WHO, 2000 classification, pancreatic mucinous cystic neoplasms (MCN) are defined by presence of ovarian stroma, and are primarily located in the pancreatic body/tail of females. The incidence of MCN and associated malignancy in males, since, standardization of MCN diagnostic-criteria is unknown.
  
  
  METHODS
  MCN resections from 2000 to 2014 at eight institutions of the Central-Pancreas-Consortium were included, and divided into early (2000-2007) and late (2008-2014) time-periods. Primary aim was to characterize MCN and associated adenocarcinoma/high-grade-dysplasia (AC/HGD) in males versus females over time.
  
  
  RESULTS
  Of 1667 resections for pancreatic cystic lesions, 349 pts (21%) had MCNs: 310 (89%) female, 39 (11%) male. Patients were equally divided between early (n = 173) and late (n = 176) time-periods. MCN in male-patients decreased over time (early: 15%, late: 7%; P = 0.036), as did pancreatic head/neck location (early: 22%, late: 11%; P = 0.01). MCN-associated AC/HGD was more frequent in males versus females (39 vs. 12%; P < 0.001). The overall rate of MCN-associated AC/HGD remained stable (early: 17%, late: 13%; P = 0.4), and was identical in males (39%) over both time-periods. Males with AC/HGD had more LN-positive disease versus females (57 vs. 22%; P = 0.039).
  
  
  CONCLUSIONS
  As the diagnostic-criteria of MCN have standardized over time, MCN diagnosis has decreased in males and head/neck location. Despite this, MCN-associated adenocarcinoma/high-grade dysplasia has been stable and remains high in males. Any male with suspected MCN, regardless of location, should undergo resection.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors.forename: Cecilia G
authors.initials: CG
authors.lastname: Ethun
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Postlewait
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors.forename: Mia R
authors.initials: MR
authors.lastname: McInnis
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Miami, Miami, Florida.|Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Nipun
authors.initials: N
authors.lastname: Merchant
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Alexander
authors.initials: A
authors.lastname: Parikh
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Kamran
authors.initials: K
authors.lastname: Idrees
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Chelsea A
authors.initials: CA
authors.lastname: Isom
authors.affiliation: Department of Surgery, Washington University School of Medicine, St Louis, Missouri.
authors.forename: William
authors.initials: W
authors.lastname: Hawkins
authors.affiliation: Department of Surgery, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Fields
authors.affiliation: Department of Surgery, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Matthew
authors.initials: M
authors.lastname: Strand
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Weber
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.|Department of Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Clifford S
authors.initials: CS
authors.lastname: Cho
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Salem
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, Kentucky.
authors.forename: Robert C G
authors.initials: RCG
authors.lastname: Martin
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, Kentucky.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Scoggins
authors.affiliation: Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: David
authors.initials: D
authors.lastname: Bentrem
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Hong J
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Jacquelyn
authors.initials: J
authors.lastname: Carr
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Cincinnati Cancer Institute, Cincinnati, Ohio.
authors.forename: Syed A
authors.initials: SA
authors.lastname: Ahmad
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.|Division of Surgical Oncology, Department of Surgery, University of Cincinnati Cancer Institute, Cincinnati, Ohio.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Abbott
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Cincinnati Cancer Institute, Cincinnati, Ohio.
authors.forename: Gregory
authors.initials: G
authors.lastname: Wilson
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors.forename: David A
authors.initials: DA
authors.lastname: Kooby
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors.forename: Shishir K
authors.initials: SK
authors.lastname: Maithel
mesh_terms: D000368:Aged; D018282:Cystadenocarcinoma, Mucinous / Q000473:pathology* / Q000601:surgery; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery; D017678:Sex Distribution; D014481:United States
keywords: high-grade dysplasia; ovarian stroma; surgical resection