Goh Brian K P, Tan Yu-Meng, Yap Wai-Ming, Cheow Peng-Chung, Chow Pierce K H, Chung Yaw-Fui Alexander, Wong Wai-Keong, Ooi London L P J
Department of Surgery, Singapore General Hospital, Outram Road, Singapore, 169608.
World J Surg. 2006 Aug;30(8):1553-9. doi: 10.1007/s00268-005-0749-7.
The preoperative distinction between serous cystic neoplasms (SCNs) and mucinous cystic neoplasms (MCNs) is essential, as all MCNs are considered malignant or potentially malignant and should be surgically resected, whereas SCNs are almost always benign. However, the radiologic distinction between SCNs and MCNs is frequently difficult especially with serous oligocystic adenoma (SOA), a morphologic variant of SCN, as both SOA and MCN appear on cross-sectional imaging as a solitary macrocystic lesion in the pancreas. We reviewed all SOAs managed at our institution to determine if any clinicopathologic features would prove useful for establishing a preoperative diagnosis.
Over a 15-year period, 64 patients with a pathologically confirmed diagnosis of a pancreatic cystadenoma or cystadenocarcinoma treated at Singapore General Hospital were retrospectively reviewed. There were 27 MCNs and 37 SCNs including 12 SOAs. In addition, 40 cases of SOA previously reported in the literature were reviewed and analyzed together with the 12 patients, making this a series of 52 SOAs.
In our experience, SOAs comprised 32.4% of the SCNs, and females predominated (7/12). The median age of the patients was 42.5 years (range 22-74 years), and only 4 of the 12 patients were symptomatic. Most of the cysts were located in the body or tail of the pancreas (9/12), and the median cyst size was 52.5 mm (range 10-190 mm). When the clinicopathologic features of SOAs and serous microcystic adenomas (SMAs) were compared, there was no difference between the patients with SOAs and SMAs in terms of age, sex, presence of symptoms, cyst size, or site of the lesion. However, SOAs occurred in the women less frequently (67.3% vs. 96.3%, P=0.004), were smaller [40 mm (range 10-190 mm) vs. 95 mm (range 25-180 mm), P<0.001], and occurred more commonly in the head of the pancreas [25 (48.1%) vs. 2(7.4%)] compared to MCNs. None of the SOAs were frankly malignant compared to the 29.6% of MCNs that were.
SOAs and SMAs have similar clinicopathologic features. On the other hand, SOAs differ from MCNs by their relatively higher male/female ratio, higher frequency of tumors occurring in the head of the pancreas, and smaller cyst size. Knowledge of these distinguishing clinical features when used in combination with other diagnostic modalities such as endoscopic ultrasonography/fine-needle aspiration will enable clinicians to better differentiate these two pathologic entities preoperatively.
术前区分浆液性囊性肿瘤（SCNs）和黏液性囊性肿瘤（MCNs）至关重要，因为所有MCNs均被视为恶性或潜在恶性，应行手术切除，而SCNs几乎总是良性的。然而，SCNs和MCNs之间的影像学区分常常很困难，尤其是浆液性少囊性腺瘤（SOA），它是SCN的一种形态学变异，因为SOA和MCN在横断面成像上均表现为胰腺内的单个大囊性病损。我们回顾了在我们机构接受治疗的所有SOA病例，以确定是否有任何临床病理特征有助于术前诊断。
回顾性分析了新加坡总医院15年间64例经病理确诊为胰腺囊腺瘤或囊腺癌的患者。其中有27例MCNs和37例SCNs，包括12例SOA。此外，将文献中先前报道的40例SOA病例与这12例患者一起进行回顾和分析，形成了一个包含52例SOA的系列研究。
根据我们的经验，SOA占SCNs的32.4%，女性居多（7/12）。患者的中位年龄为42.5岁（范围22 - 74岁），12例患者中只有4例有症状。大多数囊肿位于胰腺体部或尾部（9/12），囊肿中位大小为52.5 mm（范围10 - 190 mm）。比较SOA和浆液性微囊性腺瘤（SMAs）的临床病理特征，SOA患者和SMA患者在年龄、性别症状、囊肿大小或病损部位方面无差异。然而，SOA在女性中发生频率较低（67.3%对96.3%，P = 0.004），囊肿较小[40 mm（范围10 - 190 mm）对95 mm（范围25 - 180 mm），P < 0.001]，与MCNs相比，更常见于胰腺头部[25例（48.1%）对2例（7.4%）]。与29.6%的MCNs为恶性相比，SOA均无明显恶性表现。
SOA和SMA具有相似的临床病理特征。另一方面SOA与MCNs不同，在于其相对较高的男女比例、肿瘤在胰腺头部出现的频率较高以及囊肿较小。当将这些有鉴别意义的临床特征与其他诊断方法如内镜超声/细针穿刺相结合使用时，临床医生能够在术前更好地区分这两种病理实体。
