Skip to main content

Analysis of small cystic lesions of the pancreas

Summary

There have been few reports on (1) the nature and pathogenesis of small cystic lesions of the pancreas, (2) their incidence, age distribution, and location, and (3) their significance as potential precursors of intraductal papillary tumors, mucinous cystic tumors, and duct cell carcinomas. Materials: Epithelial growth of small cystic lesions in 300 consecutive autopsy cases and in seven cases of small duct cell carcinoma from among 2300 elderly autopsy cases, was evaluated by histopathological analysis. One hundred eighty-six cystic lesions were found in 73 of 300 autopsy cases (24.3%). The incidence of cystic lesions increased with age. Cystic lesions were equally distributed throughout the pancreas. Epithelial atypia was histologically classified into five groups: normal epithelium; papillary hyperplasia without atypia; atypical hyperplasia; carcinomain situ; and invasive carcinoma. The incidence of each group was 47.5, 32.8, 16.4, 3.4, and 0%, respectively. Epithelia of atypical hyperplasia or carcinomain situ were more prevalent in small cystic lesions (less than 4 mm in diameter) than in larger lesions (chi-square test,p<0.05). Epithelia of dilated ductular branches adjacent to cystic lesions showed a similar degree of atypia as the epithelia of the cystic lesions themselves (p<0.01). Epithelial atypia of the main pancreatic duct was mild in all of the cases but two, and was not related to that of the cystic lesion. Among the seven cases of small duct cell carcinoma, two cases had small cancerous cystic lesions, 4.1 and 5.3 mm in diameter, within the tumor. Small cystic lesions appear to have the potential to progress to malignancy but definitive evidence has not been demonstrated. Additional studies, including molecular biological examinations, are necessary to fully understand the biology of these lesions.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Gonzalez AC, Bradley EL, Clements JL. Pseudocyst formation in acute pancreatitis. Ultrasonographic evaluation of 99 cases.Am J Roentgenol 1976; 127: 315.

    CAS  Google Scholar 

  2. 2.

    Hancke S, Pedersen JF. Percutaneous puncture of pancreatic cysts guided by ultrasound.Surg Gynecol Obstet 1976; 142: 551.

    PubMed  CAS  Google Scholar 

  3. 3.

    Conrad MR, Landay MJ, Khoury M. Pancreatic pseudocysts. Unusual ultrasound features.Am J Roentgenol 1978; 130: 265.

    CAS  Google Scholar 

  4. 4.

    Morohoshi T, Kanda M, Asanuma K, Klöppel G. Intraductal papillary neoplasms of the pancreas. A clinicopathologic study of six patients.Cancer 1989; 64: 1320–1335.

    Article  Google Scholar 

  5. 5.

    Rickaert F, Cremer M, Deviere J, et al. Intraductal mucin-hypersecreting neoplasms of the pancreas. A clinicopathological study of eight patients.Gastroenterology 1991; 101: 512–519.

    PubMed  CAS  Google Scholar 

  6. 6.

    Komatsu K. Pancreatographical and histopathological study of dilations of the pancreas ductules with special references to cystic dilatations.Juntendo Med J 1974; 19: 250–269.

    Google Scholar 

  7. 7.

    Kimura W, Shimada H, Kuroda A, Morioka Y. Carcinoma of the gallbladder and extrahepatic bile duct in autopsy cases of the aged, with special reference to its relationship to gallstones.Am J Gastroenterol 1989; 84: 386–390.

    PubMed  CAS  Google Scholar 

  8. 8.

    Kimura W. Histological study on pathogenesis of sites of isolated islets of Langerhans and their course to the terminal state.Am J Gastroenterol 1989; 84: 517–522.

    PubMed  CAS  Google Scholar 

  9. 9.

    Kimura W, Kuroda A, Morioka Y. Clinical pathology of endocrine tumors of the pancreas. Analysis of autopsy cases.Dig Dis Sci 1991; 36: 933–942.

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Kimura W, Ohtsubo K. Incidence, sites of origin, and immunohistochemical and histochemical characteristics of atypical epithelium and minute carcinoma of the papilla of Vater.Cancer 1988; 61: 1394–1402.

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Caironi C, Fraschini A, Ambrogi G, Canali B. Notes on pancreatic cysts in the light of three personal cases.Pan Med 1980;22: 17–20.

    CAS  Google Scholar 

  12. 12.

    Cubilla AL, Fitzgerald PJ. Tumors of the exocrine pancreas, inAtlas of Tumor Pathology, 2nd ser. Fascicle 19, Hartmann WH, Sobin LH, eds., Armed Forces Institute of Pathology, Washington, DC, 1984.

    Google Scholar 

  13. 13.

    Sommers SC, Murphy SA, Warren S. Pancreatic duct hyperplasia and cancer.Gastroenterology 1954; 27: 629–640.

    PubMed  CAS  Google Scholar 

  14. 14.

    Cubilla AL, Fitzgerald PJ. Morphological patterns of primary nonendocrine human pancreas carcinoma.Cancer Res 1975; 35: 2234–2248.

    PubMed  CAS  Google Scholar 

  15. 15.

    Cubilla AL, Fitzgerald PJ. Cancer of the pancreas (non-endocrine): a suggested morphologic classification.Seminars Oncol 1979; 6: 285–297.

    CAS  Google Scholar 

  16. 16.

    Cubilla AL, Fitzgerald PJ. Classification of pancreatic cancer (nonendocrine).Mayo Clin Proc 1979; 54: 449–458.

    PubMed  CAS  Google Scholar 

  17. 17.

    Longnecker DS, Shinozuka H, Dekker A. Focal acinar cell dysplasia in human pancreas.Cancer 1980; 45: 534–540.

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Chen J, Baithun SI. Morphological study of 391 cases of exocrine pancreatic tumors with special reference to the classification of exocrine pancreatic carcinoma.J Pathol 1985; 146: 17–29.

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Jones EC, Suen KC, Grant DR, Chan NH. Fine needle aspiration cytology of neoplastic cysts of the pancreas.Diagnostic Cytopathology 1987; 3: 238–243.

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Furuta K, Watanabe H, Ikeda S. Difference between solid and duct-ectatic types of pancreatic ductal carcinomas.Cancer 1992; 69: 1327–1333.

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Sommers SC, Murphy SA, Warren S. Pancreatic duct hyper-plasia and cancer.Gastroenterology 1954; 27: 629–640.

    PubMed  CAS  Google Scholar 

  22. 22.

    Cubilla AL, Fitzgerald PJ. Morphological patterns of primary nonendocrine human pancreas carcinoma.Cancer Res 1975; 35: 2234–2248.

    PubMed  CAS  Google Scholar 

  23. 23.

    Pour PM, Sayed S, Sayed G. Hyperplastic, preneoplastic and neoplastic lesions found in 83 human pancreases.Am J Clin Pathol 1982; 77: 137–152.

    PubMed  CAS  Google Scholar 

  24. 24.

    Kozuka S, Sassa R, Masamoto K, Nagasawa S, Saga S, Hasegawa K, Takeuehi M. Relation of pancreatic duct hyperplasia to carcinoma.Cancer 1979; 43: 1418–1428.

    PubMed  Article  CAS  Google Scholar 

  25. 25.

    Klöppel G. Pancreatic non-endocrine tumors, inPancreatic Pathology, Klöppel G, Heitz P, eds., Churchill Livingston Edinburgh, 1984; 79–113.

    Google Scholar 

  26. 26.

    Compagno J, Oertel JE. Mucinous cystic neoplasms of the pancreas with overt and latent malignancy (cystadenocarcinomas and cystadenoma).Am J Clin Pathol 1978; 69: 573–580.

    PubMed  CAS  Google Scholar 

  27. 27.

    Yamaguchi K, Fujoji M. Cystic neoplasms of the pancreas.Gastroenterology 1987; 92: 1934–1943.

    PubMed  CAS  Google Scholar 

  28. 28.

    Hodgikinson DJ, ReMine WH, Weiland LH. Pancreatic cystadenoma. A clinicopathological study of 45 cases.Arch Surg 1978; 113: 512–519.

    Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Wataru Kimura.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Kimura, W., Nagai, H., Kuroda, A. et al. Analysis of small cystic lesions of the pancreas. International Journal of Pancreatology 18, 197–206 (1995). https://doi.org/10.1007/BF02784942

Download citation

Key Words

  • Small cystic lesion of the pancreas
  • dilated ductular branches
  • duct cell carcinoma
  • pathogenesis
  • mucin-producing tumor