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Management of Mucin-Producing Cystic Neoplasms of the Pancreas

Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA

Key Words. Pancreas • Intraductal papillary mucinous neoplasm • Mucinous cystic neoplasm • Pancreatectomy • IPMN • MCN

Correspondence: Correspondence: Sarah P. Thayer, M.D., Ph.D., Department of Surgery, Massachusetts General Hospital, 15 Parkman Street, WACC 460, Boston, Massachusetts 02114, USA. Telephone: 617-726-0624; Fax: 617-726-0630; e-mail: sthayer{at}partners.org

Received September 2, 2008; accepted for publication December 29, 2008.

Disclosures: Stefan Fritz: None; Andrew L. Warshaw: None; Sarah P. Thayer: None The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the authors, planners, independent peer reviewers, or staff managers.

During the last decade small lesions of the pancreas have been increasingly recognized in clinical practice. Among these lesions, mucin-producing cystic neoplasms represent a recently described and unique entity among pancreatic tumors. In 1996, the World Health Organization distinguished two different types of mucinous cystic tumors: intraductal papillary mucinous neoplasms (IPMNs) of the pancreas, which are characterized by mucin production, cystic dilation of the pancreatic ducts, and intrapapillary growth, and mucinous cystic neoplasms (MCNs), which are defined by ovarian-like stroma and in most cases do not communicate with pancreatic ducts. Further, IPMNs can be subdivided into main-duct type, mixed-type, and branch-duct type tumors. Older data did not distinguish among different subsets of cystic neoplasms of the pancreas, and consequently many databases were inconsistent. Histopathologically, both IPMNs and MCNs demonstrate a wide spectrum of cellular atypia ranging from mild mucinous hyperplasia to invasive adenocarcinoma. Because mucinous cystic neoplasms of the pancreas show significant differences in clinical behavior from patient to patient, knowledge of the clinicopathologic characteristics and natural history of specific subtypes of IPMNs and MCNs has become crucial for physicians working in the field of gastroenterology. The present work offers an overview of current and generally accepted clinical guidelines for the diagnosis and treatment of IPMNs and MCNs.