Team IV

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Team IV Surgical Oncology

• Ed Chin, MD
• September 21, 2004

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Case 2

• 34F, healthy, recently post-partum
• Abdominal mass noted by OB-Gyn
• No hx pancreatitis, weight loss
• CT scan
• 20 cm cystic mass
• Splenic vein thrombosis?

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OR
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OR
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OR
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Operative Course
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OR
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Postop Course

• Diet advanced
• Diarrhea ? c. diff
• D/cd POD6 with PO flagyl
• JP removed in office
• Pathology
• mucinous cystadenoma
• CEA 689
• CA 19-9 42

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Cystic Pancreatic Neoplasms

• Serous cystadenoma (32-39)
• Mucinous cystadenoma (10-45)
• Intraductal Papillary Mucinous Neoplasm (21-33)
• Solid pseupapillary neoplasm (lt10)
• Cystic endocrine neoplasm (lt10)
• Ductal adenoca with cystic degeneration (lt1)
• Acinar-cell cystadenocarcinoma (lt1)

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Diagnosis

• Serous and mucinous neoplasms
• Mean age 50 yrs
• Female male 41
• Asymptomatic (lt 75)
• Symptoms
• Abdominal pain
• Mass
• Jaundice
• Prior pancreatitis

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Serous Cystic Neoplasms

• Most common
• Minimal malignant potential (lt 10 reports)
• Multiple cysts
• Polycystic (70)
• Oligocystic
• Honeycomb
• Central stellate scar/calcification (30)

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Mucinous Cystic Neoplasms

• Majority in body/tail
• Thick capsule
• No communication w/ duct

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IPMN

• Proximal sites
• Cystic dilatation of main PD or side branch
• Mucin-filled ampulla

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Cystic Pancreatic Lesions
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Treatment

• Serous cystic lesions
• Resection only for symptoms, or ambiguity
• Enucleation, central pancreatectomy?
• Mucinous cystic lesions
• All require resection 2nd malignant potential
• Operation based on location
• IPMN
• Surgery indicated
• Total pancreatectomy vs. subtotal w/ frozen
  section margin

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Algorithm
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Results

• Generally favorable
• 5 yr survival
• mucinous cystadenoma gt 95
• Mucinous ca 17-33
• IPMN gt 50 lt30 if invasive
• Surveillance?