Mucinous cystic neoplasm (MCN) with low- or intermediate-grade dysplasia

Mucinous cystic neoplasm (MCN) with low- or intermediate-grade dysplasia
Pancreas

Definition

A benign or low malignant potential cystic epithelial neoplasm composed of cells which contain intracytoplasmic mucin.

Mucinous cystic neoplasms (MCN) with low-or intermediate-grade of dysplasia of the pancreas
Mucinous cystic neoplasms (MCN) are categorized as:
> MCN with low-or intermediate-grade of dysplasia, previously called mucinous cystadenoma
> MCN with high grade of dysplasia previously called mucinous cystadenocarcinoma, non-invasive
> MCN with an associated invasive carcinoma if there is a component of invasive carcinoma.

MCNs of the pancreas are cyst-forming epithelial neoplasm that usually does not communicate with the pancreatic ductal system, and is composed of columnar, mucin-producing epithelium associated with ovarian-type subepithelial stroma

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Hamilton SR, Aaltonen LA (eds.)
WHO Classification of Tumours of the Digestive System.
IARC
Lyon 2000

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Hruban RH, Pitman MB, and Klimstra DS
Tumors of the Pancreas. Armed Forces Institute of Pathology
Washington, DC 2007

. This neoplasm occurs almost exclusively in women. MCNs are relatively rare, accounting for about 8% of surgically resected cystic lesions of the pancreas

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Kosmahl M, Pauser U, Peters K, Sipos B, Lüttges J, Kremer B, Klöppel G (2004)
Cystic neoplasms of the pancreas and tumor-like lesions with cystic features: a review of 418 cases and a classification proposal.
Virchows Arch 445: 168-78

. A MCN should be suspected whenever a cystic lesion is seen by endoscopic ultrasonography (EUS), computed tomography (CT) or magnetic resonance imaging (MRI) in the pancreatic body–tail of a young or middle-aged woman, especially in the absence of a history of pancreatitis. MCNs have two distinct components – an epithelial lining and an underlying ovariantype stromal component. The possibility that the stromal component of MCNs is derived from ovarian primordium is supported by morphology, tendency to undergo luteinization, presence of hilar-like cells, and immunophenotypic sex cord–stromal differentiation. Surgical resection is curative for almost all patients with a noninvasive MCN

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Crippa S, Salvia R, Warshaw AL, Domínguez I, Bassi C, Falconi M, Thayer SP, Zamboni G, Lauwers GY, Mino-Kenudson M, Capelli P, Pederzoli P, Castillo CF (2008)
Mucinous cystic neoplasm of the pancreas is not an aggressive entity: lessons from 163 resected patients.
Ann Surg 247: 571-9

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Sarr MG, Carpenter HA, Prabhakar LP, Orchard TF, Hughes S, van Heerden JA, DiMagno EP (2000)
Clinical and pathologic correlation of 84 mucinous cystic neoplasms of the pancreas: can one reliably differentiate benign from malignant (or premalignant) neoplasms?
Ann Surg 231: 205-12

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Wilentz RE, Albores-Saavedra J, Zahurak M, Talamini MA, Yeo CJ, Cameron JL, Hruban RH (1999)
Pathologic examination accurately predicts prognosis in mucinous cystic neoplasms of the pancreas.
Am J Surg Pathol 23: 1320-7

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Zamboni G, Scarpa A, Bogina G, Iacono C, Bassi C, Talamini G, Sessa F, Capella C, Solcia E, Rickaert F, Mariuzzi GM, Klöppel G (1999)
Mucinous cystic tumors of the pancreas: clinicopathological features, prognosis, and relationship to other mucinous cystic tumors.
Am J Surg Pathol 23: 410-22

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Bosman FT, Carneiro F, Hruban RH, Theise ND (Eds.)
WHO Classification of Tumours of the Digestive System.
4th Edition
International Agency for Research on Cancer: Lyon 2010

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Commentary: Preneoplastic lesions of the digestive system