Goh Brian K P, Tan Yu-Meng, Chung Yaw-Fui A, Chow Pierce K H, Cheow Peng-Chung, Wong Wai-Keong, Ooi London L P J
Department of Surgery, Singapore General Hospital, Outram Road, Singapore, 169608.
World J Surg. 2006 Dec;30(12):2236-45. doi: 10.1007/s00268-006-0126-1.
Despite formal definitions of mucinous cystic neoplasms (MCNs) and intraductal papillary neoplasms (IPMNs) by the World Health Organization (WHO) and Armed Forces Institute of Pathology (AFIP), several controversies with regard to MCNs remain. The aim of this review was to determine the clinicopathological features of MCNs defined by ovarian-type stroma (OS) as proposed by the WHO and AFIP and to compare them with MCNs defined by less stringent criteria.
A MEDLINE search was conducted to identify English-language articles on pancreatic MCNs from 1996 to 2005. Twenty-five studies were identified. The studies were divided into 2 groups: group A included 10 studies with 344 patients whereby the presence of OS was a criteria for the diagnosis of MCNs, and group B, included 15 studies comprising 761 patients whereby the presence of OS was not mandatory for the diagnosis of MCNs.
Patients in group A (MCNs as defined by OS) were almost always female (99.7%), with a mean age of 47 (range, 18-95) years. MCNs were located predominantly in the body or tail of the pancreas (94.6%) and had a mean size of 8.7 cm (range, 0.6-35 cm); 76% were symptomatic, 6.8% demonstrated ductal communication, and 27% were malignant. At a mean follow-up of 57.5 (range, 1-264) months and 43 (range, 2-257) months after surgery, 97.9% of benign and 61.9% of malignant neoplasms were disease free, respectively. Patients in group B were older and had a higher proportion of males. Neoplasms were more evenly distributed in the pancreas, were smaller, communicated more frequently with the pancreatic duct, and were composed of a higher proportion of malignant tumors compared with group A. Their clinicopathological features were intermediate between those of group A and patients with IPMN.
Pancreatic MCNs with OS have unique and distinct clinicopathological features. MCNs should be defined by the presence of OS, as it is the most reliable way of distinguishing MCNs from IPMN. Adoption of "looser" criteria will result in misclassification of some IPMNs as MCNs.
尽管世界卫生组织（WHO）和武装部队病理研究所（AFIP）对黏液性囊性肿瘤（MCNs）和导管内乳头状肿瘤（IPMNs）给出了正式定义，但关于MCNs仍存在一些争议。本综述的目的是确定WHO和AFIP提出的由卵巢型间质（OS）定义的MCNs的临床病理特征，并将其与由不太严格标准定义的MCNs进行比较。
进行MEDLINE检索，以识别1996年至2005年关于胰腺MCNs的英文文章。共识别出25项研究。这些研究分为两组：A组包括10项研究，共344例患者，其中OS的存在是诊断MCNs的标准；B组包括15项研究，共761例患者，其中OS的存在不是诊断MCNs的必需条件。
A组患者（由OS定义的MCNs）几乎均为女性（99.7%），平均年龄47岁（范围18 - 95岁）。MCNs主要位于胰腺体部或尾部（94.6%），平均大小为8.7 cm（范围0.6 - 35 cm）；76%有症状，6.8%显示与导管相通，27%为恶性。术后平均随访57.5个月（范围1 - 264个月）和43个月（范围2 - 257个月），分别有97.9%的良性肿瘤和61.9%的恶性肿瘤无疾病进展。B组患者年龄较大，男性比例较高。与A组相比，肿瘤在胰腺内分布更均匀，体积更小，与胰管相通更频繁，恶性肿瘤比例更高。其临床病理特征介于A组患者和IPMN患者之间。
具有OS的胰腺MCNs具有独特且明显的临床病理特征。MCNs应通过OS的存在来定义，因为这是区分MCNs与IPMN的最可靠方法。采用“宽松”标准会导致一些IPMN被误分类为MCNs。
