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Prognosis of Minimally Invasive Carcinoma Arising in Mucinous Cystic Neoplasms of the Pancreas

Lewis, Gloria H. MD*; Wang, Huamin MD, PhD; Bellizzi, Andrew M. MD‡,§; Klein, Alison P. PhD*,∥,¶; Askin, Frederic B. MD*; Schwartz, Lauren Ende MD#; Schulick, Richard D. MD**; Wolfgang, Christopher L. MD, PhD**; Cameron, John L. MD**; O’Reilly, Eileen M. MD††; Yu, Kenneth H. MD††; Hruban, Ralph H. MD*,¶

The American Journal of Surgical Pathology: April 2013 - Volume 37 - Issue 4 - p 601–605
doi: 10.1097/PAS.0b013e318273f3b0
Original Articles

Although patients with surgically resected noninvasive mucinous cystic neoplasms (MCNs) of the pancreas are cured, the behavior of surgically resected minimally invasive adenocarcinomas arising in MCN has not been well established. We report 16 surgically resected MCNs with minimal invasion defined as unifocal or multifocal microscopic invasive adenocarcinoma confined to the ovarian stroma of the MCN without capsular or pancreatic parenchymal invasion. Pathologic findings were correlated with patient demographics, type of surgery, and long-term follow-up. Our study included 15 women and 1 man ranging in age from 25 to 66 years. The patients were followed up for a mean of 48.6 months (range, 12 to 148 mo). The MCNs ranged in size from 3.5 to 25 cm and were all located in the body/tail of the gland. Lymphovascular invasion was not identified in any of the cases, and all lymph nodes were negative for tumor. Ten neoplasms had unifocal invasion, whereas 6 had multifocal invasion. Twelve of the neoplasms were partially submitted for microscopic examination, whereas 4 were submitted entirely. Only 1 of the 16 minimally invasive MCNs recurred, and that tumor had been lighlty sampled pathologically. Our study demonstrates that the majority of patients with minimally invasive adenocarcinoma arising in MCNs are cured by surgery, particularly if the neoplasms are completely examined histologically.

Departments of *Pathology

Epidemiology

Oncology

**Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD

Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX

Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA

§Department of Pathology, Brigham and Women's Hospital, Boston, MA

#Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA

††Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY

Conflicts of Interest and Source of Funding: Supported by NIH P50CA062924, The Sol Goldman Pancreatic Cancer Research Center, and The Michael Rolfe Foundation for Pancreatic Cancer Research. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Correspondence: Ralph H. Hruban, MD, Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins Hospital, 401 North Broadway, Weinberg Building 2242, Baltimore, MD 21231 (e-mail: rhruban@jhmi.edu).

© 2013 Lippincott Williams & Wilkins, Inc.