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At least 19 recordsLinked to original sources
PubMed2003

Discrimination of unilocular macrocystic serous cystadenoma from pancreatic pseudocyst and mucinous cystadenoma with CT: initial observations.

PURPOSE: To compare the computed tomographic (CT) appearance of pancreatic unilocular macrocystic serous cystadenoma, mucinous cystadenoma, and pseudocyst to determine if there are findings that assist in the differential diagnosis. MATERIALS AND METHODS: CT findings in 33 patients (24 women, nine men; age range, 18-84 years; mean age, 41 years) with unilocular pancreatic lesions (macrocystic serous cystadenoma, n = 12; mucinous cystadenoma, n = 11; pseudocyst, n = 10) were retrospectively and jointly reviewed by two blinded observers. Twenty-three patients underwent helical CT, which included pancreatic and portal venous phase imaging with delays of 40 seconds and 65 seconds, respectively, after contrast material injection. Ten patients underwent conventional (nonhelical) CT. The number, size, location, and contour of lesions were reviewed, along with wall thickness and enhancement and other signs of pancreatic and peripancreatic involvement. Diagnosis was based on lesion resection (n = 22) or on a combination of cytologic findings, biochemical markers, and tumor markers (n = 11). The Fisher exact test was used to analyze the results. RESULTS: Three of four CT findings were independently specific for macrocystic serous cystadenoma: location in the pancreatic head, lobulated contour, and absence of wall enhancement. When two of these four criteria were used in combination, 83% (10 of 12) of patients with unilocular macrocystic serous cystadenoma were identified. When three or four of these criteria were used, a specificity of 100% was achieved. Location in the pancreatic head (P <.05), lobulated contour (P <.005), and lack of wall enhancement (P <.005) were specific for macrocystic serous cystadenoma in comparison with mucinous cystic tumor. Lobulated contours (P <.005) were specific for macrocystic serous cystadenoma in comparison with pseudocyst. Other CT findings were not helpful in distinguishing between the three types of lesions. CONCLUSION: A combination of CT findings is helpful in making the diagnosis of pancreatic unilocular macrocystic serous cystadenoma.

Adolescent↗
PubMed2005

Mixed serous cystadenoma with mucinous cystadenoma of the pancreas.

We report a case of serous cystadenoma of the pancreas mixed with mucinous cystadenoma. A 65-year-old woman was admitted to our hospital for evaluation of a palpable, elastic, hard mass measuring 6 cm in diameter in the right upper quadrant of the abdomen. A diagnosis of mucinous cystadenocarcinoma of the pancreas was made, and pancreatoduodenectomy was performed. The tumor was composed of a dominant compartment of macroscopic cyst, and its thick wall was filled with numerous microscopic cysts. The light microscopy findings with hematoxylin and eosin staining, and by the periodic acid-Schiff reaction, were almost perfectly consistent with the characteristics of microcystic or glycogen-rich cystadenoma, but the apical portion of the cytoplasm of the neoplastic cells was stained with Alcian blue at pH 2.4 and by the mucicarmine method. Neoplastic cells containing epithelial acidic mucin are usually found in mucinous cystadenomas. No K-ras point mutations were detected at the sites where neoplastic cells were present, whether or not they contained epithelial acidic mucin. Pancreatic serous cystadenomas that include a mucinous-cystadenoma component are extremely rare, and the difference between serous and mucinous cystadenomas is not always distinct.

Aged↗
PubMed2004

Simultaneous serous cystadenoma of the pancreas and mucinous cystadenoma of the appendix.

CONTEXT: Serous cystadenoma of the pancreas and mucinous tumors of the vermiform appendix are rare. To our knowledge, the simultaneous occurrence of these two tumors has not been reported. CASE REPORT: Here, we report an adult female who presented with signs and symptoms of appendicitis. A preoperative CT scan confirmed the findings of appendicitis and also showed an incidental large mass in the head of the pancreas. The patient underwent uneventful appendectomy. Her pathology revealed an acutely inflamed appendix with a benign mucinous cystadenoma at the tip. Several months after her recovery, a Whipple procedure was performed. Pathologic examination showed a 5x5 cm serous cystadenoma of the head of the pancreas without evidence of malignancy. Two years later, the patient is alive and well without evidence of tumor recurrence. CONCLUSIONS: Cystadenomas of the pancreas and appendix are unusual and their simultaneous occurrence is a rare event.

Appendiceal Neoplasms↗
PubMed1978

Mucinous cystadenoma, serous cystadenoma and benign cystic teratoma of the ovary: clinico-pathologic differences observed in a Malaysian hospital.

A study of 207 benign ovarian tumors seen at the University Hospital, Kuala Lumpur between 1968 and 1975 was made to evaluate the clinical features that might be useful in the preoperative differentiation of mucinous cystadenoma, serous cystadenoma, and cystic teratoma of the ovary. This study indicated that the pertinent information included the mean age of the patient, the marital and menstrual status, and the estimated tumor size. The racial background was an additional factor in serous cystadenoma. Features like parity, the location of the tumor, and ABO blood group pattern were of no value in the preoperative differentiation.

Adult↗
PubMed2004

Mucinous cystadenoma with mesenchymal over-growth: a new variant among pancreatic mucinous cystadenomas?

We report an unusual type of mucinous cystadenoma of the pancreas, characterised by a predominantly solid gross appearance due to the presence of an abundant ovarian-type stroma. The tumour, located in the body of the pancreas, was discovered after episodes of acute pancreatitis. It was composed of several mucus-secreting benign cysts placed within a highly cellular ovarian-type stroma, composed of undifferentiated spindle cells with mild atypia but without any increase of mitotic activity and with a low proliferative index. These cells expressed oestrogen and progesterone receptors, but they did not express CD34, CD117, p53 protein or bcl-2. Recognition of this peculiar mainly solid mucinous cystadenoma containing an abundant ovarian-type stroma is difficult. It is conceivable that the mesenchymal component described in our case could represent an early stage in the development of sarcoma in mucinous cystadenoma of the pancreas.

Adult↗
PubMed1996

Hepatobiliary cystadenoma with mesenchymal stroma (CMS) in association with unilateral mucinous cystadenoma of the ovary (MCO): case report and review of the literature.

The case of a patient with a cystadenoma with mesenchymal stroma (CMS) of the liver in association with asymptomatic unilateral mucinous cystadenoma of the right ovary (MCO) is reported. Immunohistochemical analysis of both lesions showed an identical profile. CA19-9 was expressed in the epithelial lining of both, intrahepatic CMS and MCO, without a parallel serum elevation. A probable common pathway of synchronous histogenesis for these lesions is hypothesised. The etiology of CMS remains obscure suggesting a multifactorial process implicating sex-related (hormone-dependent?) synergic and environmental factors, which probably act in different stages of organogenesis. Partial hepatectomy and right salpingo-oophorectomy were performed. Four years after surgery, the patient remains well with no evidence of residual or recurrent disease.

CA-19-9 Antigen↗
PubMed2004

Macrocystic pancreatic cystadenoma: The role of EUS and cyst fluid analysis in distinguishing mucinous and serous lesions.

BACKGROUND: Benign pancreatic serous cystadenoma usually is morphologically distinguishable from mucinous cystadenomas, which require resection because of their malignant potential. A macrocystic variant of serous cystadenoma recently has been described, rendering this important distinction more difficult. The aim of this study was to determine the EUS and tumor marker characteristics of mucinous cystadenoma compared with macrocystic serous cystadenomas. METHODS: Medical records for consecutive patients seen between 1995 and 2002, with a histopathologic diagnosis of mucinous cystadenoma or macrocystic serous cystadenoma after surgery, who had undergone a detailed EUS examination, including EUS-guided FNA, were retrospectively reviewed. RESULTS: A resection specimen was available for 32 mucinous cystadenomas and 9 macrocystic serous cystadenomas. No significant differences were observed with regard to clinical data (age, gender, presence of symptoms), lesion size, and location within the pancreas. All mucinous cystadenomas had a discernible cyst wall (thickened, 66%; focal parietal nodules, 25%) compared with 56% of macrocystic serous cystadenomas (p<0.0001). A thick echo content also was more frequent in mucinous cystadenoma (56% vs. 11%; p=0.04; statistical significance removed by the Bonferroni correction). Microcysts were only observed in macrocystic serous cystadenomas (44%; p=0.0008). The combination of a cyst wall that is thickened and the absence of microcysts had a sensitivity of 100% and specificity of 78% for the diagnosis of mucinous cystadenoma compared with macrocystic serous cystadenoma. Although intracystic carbohydrate-associated antigen 72-4 and mucins M1 were non-discriminatory, low carcinoembryonic antigen (<5 ng/mL) and carbohydrate-associated antigen 19-9 (<50,000 U/mL) values were found in macrocystic serous lesions (respectively, 100% and 100%; p=0.0002 and p=0.0002). CONCLUSIONS: Although there is considerable overlap, helpful EUS characteristics that differentiate mucinous cystadenoma from macrocystic serous cystadenoma include a thick cyst wall and microcysts. These features, coupled with analysis of aspirated fluid for tumor markers (especially carcinoembryonic antigen), should help to confirm the diagnosis.

Adolescent↗
PubMed1989

[Pancreatic cystadenoma].

Pancreatic cystadenomas are infrequent cystic neoplasms which include 2 different lesions: microcystic cystadenomas and mucinous cystadenomas. Over a 37 year period, we observed 25 pancreatic cystadenomas: 15 microcystic cystadenomas and 10 mucinous cystadenomas. The microcystic cystadenomas corresponded either to a localized tumor (13 cases) or multiple diffuse cystic lesions of similar histology occurring within the context of Von Hippel-Lindau disease (2 cases). Localized or multiple microcystic cystadenomas are benign tumors with no risk of degeneration. Mucinous cystadenomas are potentially malignant large unilocular or multilocular cystic tumors. Preoperative differentiation between the 2 types of cystadenomas is based essentially on ultrasound and computed tomography to a lesser extent on angiography. Localized microcystic cystadenomas are low-density, hypervascularized solid or mixed tumors. Mucinous cystadenomas are anechogenic, often show septation, and are water-dense and avascular. They should be differentiated from a microcystic cystadenoma with unilocular cyst features (2 cases in our series) and especially from pancreatic pseudocyst, particularly in case of a history of trauma and associated chronic pancreatitis (2 cases). Multiple microcystic cystadenomas should be differentiated from congenital polycystic disease of the pancreas. Determination of the benign or malignant nature of a mucinous cystadenoma is difficult despite the contribution of ultrasonically-guided percutaneous puncture and microbiopsy. Such samples are either insufficient or too limited, incurring the risk of over looking an area of localized degeneration. However, intraoperative biopsy of pancreatic cyst wall can correct an erroneous diagnosis of pseudocyst (1 case) and avoid inappropriate internal drainage. Total excision of mucinous cystadenomas represents the only suitable solution in view of the malignant potential of this tumor.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

Molecular genetic analysis of ovarian serous cystadenomas.

Ovarian serous cystadenomas are common ovarian lesions that may be precursors of serous borderline tumors, which can in turn progress to low-grade serous carcinomas. It has been shown that low-grade serous carcinoma and serous borderline tumors are characterized by frequent mutations in BRAF or KRAS genes, but the mutational status of these genes in serous cystadenomas and the clonal nature of serous cystadenomas have not been fully investigated. We isolated cyst-lining epithelium from 30 consecutive serous cystadenomas, and analyzed their BRAF and KRAS mutational status. Wild-type sequences of BRAF and KRAS were detected in all specimens. Using the human androgen receptor gene as a polymorphic marker, we also examined the clonal status of epithelial cells in all of the serous cystadenomas. Four of 29 (14%) informative specimens were monoclonal based on the methylation pattern. These monoclonal cystadenomas were significantly (P<0.01) larger in size (>8 cm) than the nonclonal cystadenomas. These data indicate that serous cystadenomas do not contain mutations in either BRAF or KRAS genes and that most serous cystadenomas are polyclonal. Accordingly, it appears that serous cystadenomas develop as a hyperplastic expansion from epithelial inclusions with a clonal/neoplastic transformation occurring in a subset of them.

Apoptosis↗
PubMed1984

Pancreatic cystadenoma and cystadenocarcinoma.

Cystadenomas and cystadenocarcinomas are rare but not exceptional tumours of the pancreas. In this report six cases are added to the more than 300 cystadenomas and over 100 cystadenocarcinomas reported in the literature. We present here the case histories of four cystadenomas and two cystadenocarcinomas with complete follow-up. There is no evidence of recurrence after a maximum of 22 years in cystadenoma and 4 years in cystadenocarcinoma following resection. We have the impression that cystic lesions of the pancreas are nowadays more often detected than in former years. This might be due to abdominal investigation by computerized tomography and ultrasound on a large scale. Pathological features of proliferative cystic lesions of the pancreas permit distinction of three different tumours: serous cystadenoma, mucinous cystadenoma and cystadenocarcinoma. The serous cystadenoma is benign. The mucinous cystadenoma has to be considered as potentially malignant. The cystadenocarcinoma is malignant by definition. As benign and malignant elements can be found in the same cyst biopsy cannot exclude cystadenocarcinoma. Therefore all cystadenomas and cystadenocarcinomas should be totally excised, especially as prognosis after resection of cystadenocarcinoma is much better than after resection of adenocarcinoma of the pancreas.

Adult↗
PubMed2005

Cystadenoma and cystadenocarcinoma of the liver: a single center experience.

BACKGROUND: Biliary cystadenomas and cystadenocarcinomas comprise 5% of cystic lesions in the liver. Cystadenomas are often incorrectly diagnosed as simple cysts, which results in inadequate therapy. Recurrence and possible malignant transformation are consequences of incomplete excision. Cystadenocarcinomas are very rare tumors that are felt to be biologically indolent. STUDY DESIGN: A retrospective review of 18 cystadenomas and 4 cystadenocarcinomas treated at the Cleveland Clinic from July 1985 to November 2002. RESULTS: All 18 patients with cystadenomas were women; mean age was 48 years. The majority (16 of 18) were symptomatic. Preoperative CT scans demonstrated cyst(s) with septations in all patients. Fifty-five percent had undergone prior intervention(s) to treat the cyst. Thirteen patients had complete excision of the cystadenoma, either by enucleation or liver resection. None of the patients developed recurrent cystadenomas (mean followup 37 months). Of 4 patients with cystadenocarcinoma, 3 were women; mean age was 60 years. All were symptomatic. Preoperative CT scans demonstrated masses with both cystic and solid components. No patient had undergone prior intervention. All had a liver resection. Two patients died of metastatic disease at 6 and 12 months, respectively. One patient is alive and disease-free at 16 years; 1 is alive with metastatic disease 10 years after the liver resection. CONCLUSIONS: Cystadenomas are uncommon tumors that are often incorrectly diagnosed as simple cysts. Preoperative imaging that demonstrates the presence of internal septations highly suggests the diagnosis of cystadenoma. Intraoperative biopsy and frozen section(s) are essential, although they are not 100% accurate. Cystadenomas require complete excision to prevent recurrence and the possibility of malignant transformation. Cystadenocarcinomas are very rare. Despite complete resection, cystadenocarcinomas can recur in a short period of time. The biologic behavior of these tumors can vary widely.

Adult↗
PubMed1995

Genetic disparity between morphologically benign cysts contiguous to ovarian carcinomas and solitary cystadenomas.

BACKGROUND: Ovarian carcinomas occasionally contain large, histologically benign cysts contiguous to the clearly malignant areas (cystadenocarcinomas). The question of whether such cysts are remnants of pre-existing benign tumors (cystadenomas) or constitute integral components of the carcinomas is important in clarifying the role of cystadenomas in ovarian carcinogenesis. It is also important for our general understanding of tumor heterogeneity, a phenomenon thought to result from the gradual accumulation of genetic abnormalities in initially homogeneous tumors. This question is also pertinent to the clinical management of ovarian cystadenomas, which are frequent in women of childbearing age and are usually treated surgically based on the possibility that they may give rise to carcinomas. PURPOSE: Reasoning that molecular markers of ovarian malignancy would be confined to the histologically malignant portions of cystadenocarcinomas if the morphologically benign portions are in fact pre-existing typical cystadenomas, we sought to verify that mutations in the p53 tumor suppressor gene are markers of malignancy in ovarian tumors and to determine the distribution of such mutations in cystadenocarcinomas. METHODS: We used immunohistochemical and DNA-sequencing techniques to analyze 46 ovarian carcinomas, 21 ovarian tumors of low malignant potential, and 16 solitary cystadenomas for the presence of p53 mutations. We then used similar techniques to examine the distribution of such mutations in different portions of cystadenocarcinomas. The observed differences in mutation frequencies were analyzed by the two-tailed Fisher's exact test. RESULTS: Mutations in the p53 gene were present in 24 (52%) of the 46 carcinomas, but they were absent in the 21 tumors of low malignant potential (P < .0001) and the 16 solitary cystadenomas (P = .0002). Six of six cystadenocarcinomas with p53 mutations showed the presence of the same mutations in the adjacent, histologically benign cysts. The mutations were seen not only in cells immediately adjacent to the carcinomas, but also throughout the morphologically benign cysts. Twenty (83%) of the 24 cases showing mutation of one p53 allele also showed loss of genetic heterozygosity, suggesting that the other p53 allele was deleted. Such allelic loss, if present in morphologically malignant portions of cystadenocarcinomas, was also observed in the contiguous cysts. CONCLUSIONS: Ovarian carcinomas can be distinguished from ovarian cystadenomas and tumors of low malignant potential by p53 mutations. The fact that the mutations were present in histologically benign cysts contiguous to ovarian carcinomas suggests that such cysts are not typical cystadenomas and may carry a genetic predisposition to carcinogenesis that is not present in ordinary cystadenomas.

Carcinoma↗
PubMed1994

Hepatobiliary cystadenoma and cystadenocarcinoma. A light microscopic and immunohistochemical study of 70 patients.

Fifty-two hepatobiliary cystadenomas and 18 hepatobiliary cystadenocarcinomas were drawn from the files of the Armed Forces Institute of Pathology and Rhode Island Hospital and studied in an attempt to correlate light microscopic features of the tumors with immunohistochemical and follow-up data. The cystadenoma patients ranged in age from 2 to 87 years at the time of initial diagnosis (mean, 45 years). All the cystadenomas were multilocular with benign cuboidal to columnar epithelium, and 44 (85%) had densely cellular spindle cell ("ovarian-like") stromata; 96% were female. Fifty-one cystadenomas were macrocystic lesions, typically lined by mucinous epithelium; one of the benign lesions was a serous cystadenoma (microcystic adenoma) reminiscent of the more commonly encountered pancreatic lesion of the same name. The cystadenocarcinoma patients ranged in age from 24 to 90 years at the time of first diagnosis (mean, 59 years); eight patients (44%) were male. All but one of the lesions were multilocular with malignant in situ (one case) or invasive tubulopapillary (15 cases), solid (one case), or adenosquamous (one case) epithelial components. Areas of preexisting benign cystadenoma were found in six (33%), an observation suggesting that benign lesions may evolve into malignant ones in some patients. Most cystadenomas and cystadenocarcinomas arose in the liver, a few in the extrahepatic biliary system (including the gallbladder). On follow-up, the cystadenoma patients in general were successfully treated by surgical excision of the lesions in toto; patients treated by subtotal resection often had persistent symptomatic disease. Four cystadenocarcinoma patients died of their tumors; another two patients were alive with persistent disease at last follow-up. In both the benign and the malignant lesions, most tumor cells were positive on immunohistochemical staining with antibodies to cytokeratin, epithelial membrane antigen, and carcinoembryonic antigen; scattered chromogranin-positive cells also appeared in a few tumors of both types. Immunohistochemistry did not yield a diagnostic immunoprofile to distinguish cystadenoma from cystadenocarcinoma or from other epithelial lesions arising within the abdominal cavity. At least two types of cystadenocarcinoma exist, one developing exclusively in female patients, usually accompanied by an "ovarian-like" stroma, which follows an indolent course; and the other, lacking the distinctive cellular stroma, seen in males, follows a more aggressive course and is more likely to result in the patient's death from tumor. It remains an open question whether the cystadenocarcinomas lacking a mesenchymal stroma, which arise in women, will follow the same aggressive course as similar lesions arising in men.

Adolescent↗
PubMed1995

[Diagnosis of cystadenomas and cystadenocarcinomas of the pancreas. Study of 35 cases].

OBJECTIVES: The aims of this study were to assess the circumstances of diagnosis and accuracy of imaging procedures in patients with cystic pancreatic tumours. METHODS: Thirty-five consecutive patients with cystic pancreatic tumours (serous cystadenomas: n = 19, mucinous cystadenomas: n = 9, cystadenocarcinomas: n = 7) were studied from 1988 to 1993. Respective diagnostic values of ultrasonography, endoscopic ultrasonography, CT scan and analysis of cyst fluid were evaluated. RESULTS: The circumstances of diagnosis were abdominal pain (74%), weight loss (23%), jaundice (8%), abdominal mass (6%), asymptomatic (6%). Initial diagnosis of cystadenoma was correctly made by ultrasonography, CT scan and endoscopic ultrasonography in 63%, 77% and 84%, and the type of cystadenoma was correctly diagnosed in 20%, 51% and 55%. A pseudocyst was falsely diagnosed in 28%, 12% and 3%, respectively. After blind review of CT scans and endoscopic ultrasonography records, the type of cystadenoma was correctly diagnosed in 82% by both procedures. Cytological examination of cyst fluid of 18 cystic tumours gave correct diagnosis in 10 cases with sufficient material. A low CEA (P < 0.002), Ca 19.9 (P < 0.003) and absence of mucins (P < 0.002) in cyst fluid was evocative of serous cystadenoma. CONCLUSIONS: Abdominal pain was the main circumstance of diagnosis in cases of pancreatic cystadenomas. The type of cystadenoma was correctly diagnosed in 82% by CT scan and endoscopic ultrasonography. Cytological examination, tumoural marker and mucin levels in cyst fluid were helpful for an accurate diagnosis of cystic tumours.

Adult↗