Cystic neoplasms of the pancreas. A clinicopathologic study, including DNA flow cytometry
D. R. Brenin, M. S. Talamonti, E. Y. Yang, S. F. Sener, G. K. Haines, R. J. Joehl and D. L. Nahrwold
Department of Surgery, Northwestern University Medical School, Chicago, IL, USA.
OBJECTIVE: To review the classification, clinical behavior, and appropriate
therapy for cystic neoplasms of the pancreas. We examined patient
demographics, clinical parameters, preoperative imaging modalities,
histologic findings, and tumor DNA content to determine which best predict
outcome. DESIGN: Case series and survey of pathologic specimens. SETTING:
Tertiary care center. PATIENTS: Twenty-two patients with cystic neoplasms
of the pancreas treated at affiliates of Northwestern University Medical
School, Chicago, Ill. MAIN OUTCOME MEASURES: Predictive value of
preoperative testing, tumor DNA content, patient survival. RESULTS: In 20
patients undergoing computed tomographic scan, the tumor was visualized in
every case. All other imaging studies evaluated were less likely to
demonstrate the lesion. Eight of 10 patients with serous cystadenomas were
alive with no evidence of disease at the time of this report; one patient
was alive with local recurrence, and a second patient had died of unrelated
causes. All patients with mucinous cystadenomas were alive with no evidence
of disease. Three of seven patients with cystadenocarcinomas had aneuploid,
high S-phase tumors, and one had a diploid, high S-phase tumor; all four
died (mean survival, 4.8 months). Two patients with cystadenocarcinomas had
diploid, low S-phase tumors; both were long-term survivors but died of
their disease at 8.6 and 9.3 years. CONCLUSIONS: (1) Computed tomographic
scan is the most valuable diagnostic imaging study for preoperative
evaluation of these patients. (2) Precise preoperative determination of
tumor type is not possible. (3) DNA flow cytometry may help identify
patients with aggressive tumors who may benefit from adjuvant
chemoradiation.
