This article will help you read and understand your pathology report for pancreatic mucinous cystic neoplasm.
by Stephanie Reid MD FRCPC, reviewed by our Patient Partners on September 9, 2020
The pancreas is a long organ that sits in the abdomen just below the stomach. It is an essential part of your digestive system that makes both hormones and enzymes which help the body break down and convert the food we eat into fuel for the body’s cells. The pancreas has two main functions: an exocrine function that helps in digestion and an endocrine function that regulates blood sugar.
The exocrine part of the pancreas is made up of small structures called glands. These glands make different types of enzymes which help the body to break down food. The glands send these enzymes into the small intestine through small channels called ducts.
The endocrine part of the pancreas is made up of small round structures called acini. The acini are made up of specialized neuroendocrine cells which are like nerve cells (neurons), but they also make hormones like cells of the endocrine system (endocrine cells). They receive messages (signals) from the nervous system and the blood and respond by making and releasing hormones. These hormones control many body functions including the way your body uses sugar.
Mucinous cystic neoplasm is a tumour in the pancreas which is made up of multiple open spaces called cysts. The inside of the cysts are lined by specialized goblet cells that produce a substance called mucin.
Pancreatic mucinous cystic neoplasms are unique because the tumour contains tissue that looks like that normally found in the ovary. This ovarian type of tissue is normally found in the wall of the cyst just below the mucin producing goblet cells.
This tumour occurs most often in women around 50 years of age. It is usually located at the end of the pancreas in the area called the tail but may also be found less often in the head of the pancreas. Pancreatic mucinous cystic neoplasms tend not to produce symptoms until they become large and are usually found during imaging that is done for other reasons.
In order to make the diagnosis of pancreatic mucinous cystic neoplasm a sample of the tumour must be examined under the microscope by a pathologist. The sample needs to include the cells lining the inside of the cyst, the wall of the cyst, and some of the material inside the cyst. This type of sample can sometimes be removed during a procedure called an endoscopic ultrasound. The ultrasound is used to find the tumour and a sample of tissue is removed in either a fine needle aspiration or core needle biopsy.
For some patients, the entire tumour will need to be removed before a final diagnosis can be reached. The type of surgery performed to remove the tumour will depend on the size of the tumour and where it is located in the pancreas.
A tumour that is located at the end of the pancreas (the tail) will be removed in a procedure called a distal pancreatectomy. If the tumour is large or located near the beginning (head) of the pancreas, a special procedure called a Whipple procedure is used to remove the tumour along with part of the pancreas, small bowel, and stomach.
The prognosis for patients diagnosed with a pancreatic mucinous cystic neoplasm depends on how the tumour looks when examined under the microscope. Most tumours are benign (non-cancerous) and are cured by surgery alone. Your doctor may recommend follow-up imaging tests to make sure the tumour has been removed completely.
In rare cases a type of cancer called adenocarcinoma will develop from within the pancreatic mucinous neoplasm. Tumours with a change called dysplasia (see Dysplasia below) are associated with an increased risk of developing cancer if the tumour is not removed completely. The risk of cancer is also higher for patients with tumours greater than 5 cm.
Dysplasia is a word pathologists use to describe an abnormal pattern of growth and maturation. Most pancreatic mucinous neoplasms do not show any evidence of dysplasia. However, when dysplasia is seen, it is divided into two levels or grades: low grade dysplasia and high grade dysplasia.
Dysplasia is important because a small number of pancreatic mucinous neoplasms with dysplasia will turn into cancer over time if not completely removed. The risk of developing cancer is greater if high grade dysplasia is seen.
A margin is any tissue that was cut by a surgeon in order to remove a tumour from the body. The number of margins described in your report will depend on the type of surgery that was performed and how many cuts were made through tissues or organs to remove the tumour. Most reports will describe margins in the pancreas and in any surrounding organs that were removed at the same time as the tumour.
Commonly described margins in pancreatic resection specimens include:
All of the margins are examined under a microscope by your pathologist to determine the margin status. A margin is considered positive when there are tumour cells within 1 millimeter of the edge of the cut tissue. A margin is negative when cancer cells are more than 1 mm from the cut tissue edge. Margins are reported as negative or positive in your pathology report. Sometimes, the distance from margin may also be documented.
A positive margin means that not all of the tumour was removed during surgery. This can lead to the growth of a new tumour. If dysplasia is seen in at the margin, the potential for the dysplastic area to develop into cancer in the future remains.