Diagnosis and management of cystic pancreatic tumours with mucin production

Background: To aid selection of the most appropriate treatment for intraductal tumours (IDTs) and mucinous cystic tumours (MCTs) of the pancreas, this study describes the clinical and diagnostic features of these tumours and compares the clinicodiagnostic features of malignant and benign tumours and hyperplasia. Methods: The clinical features of 28 IDTs (four cases of hyperplasia, six adenomas and 18 adenocarcinomas) and six MCTs (four adenomas and two adenocarcinomas) were studied. Results: An IDT was found in 24 men and four women with a mean age of 64.5 years, whereas all patients with an MCT were women, with a mean age of 50.8 years. Twenty IDTs were located in the pancreatic head, whereas all MCTs were in the pancreatic body-tail. The mean size of IDTs was smaller than that of MCTs (4.4 versus 7.7 cm). The mean size of hyperplastic lesions, adenomas and adenocarcinomas in IDTs were 1.7, 2.9 and 5.4 cm respectively. Hyperplastic IDT lesions were smaller than 2 cm without either mural nodules or dilatation of the main pancreatic duct. IDTs larger than 3 cm with mural nodules and mucin secretion from an enlarged papilla orifice and dilatation of the main pancreatic duct were often adenocarcinomas. Conclusion: Although follow-up of intraductal hyperplasia is a reasonable approach, other types of IDT and MCT require surgical treatment.