Clinical Features and Natural History of Serous Cystic Neoplasm of the Pancreas

Aims: To clarify the clinical features and the natural history of serous cystic neoplasm (SCN) of the pancreas. Methods: We retrospectively analyzed data from 30 patients affected by SCN. SCNs were classified as (1) microcystic type, (2) microand macrocystic type, and (3) macrocystic type according to the modified WHO classification. Eighteen patients who underwent serial radiographic imaging were identified, and tumor growth rate in these patients was evaluated. Results: The median age was 62 years, and the female:male ratio was 2: 1. Twenty-five patients (83%) were asymptomatic and 5 (17%) were symptomatic. The median tumor size was 2.6 cm. Fifteen cases (50%) had the microcystic type, 7 (23%) the microand macrocystic type, and 8 (27%) the macrocystic type. Age, gender, symptoms, location or tumor size did not differ significantly among the three subtypes. Eighteen patients were followed up for a median of 58 months. Morphological changes were observed in 3 patients (17%) and enlargement of tumor size in 9 patients (50%) during the follow-up. The growth rate was 0.29 cm per year and doubling time was 3.5 years; these rates did not differ among morphological subtypes or size of tumors. Conclusions: In asymptomatic patients with a clear imaging diagnosis of SCN, nonReceived: March 4, 2010 Accepted after revision: August 19, 2010 Published online: January 18, 2011 Mitsuharu Fukasawa, MD, PhD Center for Gastroenterology Teine-Keijinkai Hospital 1-12-1-40 Maeda, Teine, Sapporo, Hokkaido 006-0811 (Japan) Tel. +81 11 681 8111, Fax +81 11 685 2998, E-Mail fukasawa3286 @ aol.com © 2011 S. Karger AG, Basel and IAP 1424–3903/10/0106–0695$26.00/0 Accessible online at: www.karger.com/pan Fukasawa et al. Pancreatology 2010;10:695–701 696 of the rarity and little understanding of the natural history of the SCN, there is still considerable controversy over the treatment of these tumors. Surgical resection is generally performed to relieve symptoms, if the SCN is large, or because of the inability to distinguish an SCN from a mucinous neoplasm, which has a greater malignant potential [19] . Resection of all cystic neoplasms of the pancreas has been recommended by some [20–22] , whereas others have advocated more selective approaches based on individual cases [23, 24] . The aims of the present study were to identify the clinical features and evaluate methods of diagnosis of SCNs, to clarify their natural history by reviewing serial radiographs, and finally to propose guidelines for the accurate diagnosis and optimal management of patients with SCNs.