Mucinous cystadenocarcinoma differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Qurrat-ul-ain Abid, M.D.[2]; Ammu Susheela, M.D. [3]

Overview

Mucinous cystadenocarcinoma must be differentiated from mucinous cystadenoma, serous cystadenoma, and pseudocyst.

Differentiating Mucinous cystadenocarcinoma from other Diseases

Mucinous cystadenocarcinoma of ovary

Mucinous cystadenocarcinoma of pancreas

Mucinous cystadenocarcinoma of appendix

Mucinous

cystadenocarcinoma

of ovary

Clinical manifestations Para-clinical findings Gold standard
Sign and symptoms Physical

examination

Lab Findings Imaging Histopathology
US CT MRI
Mucinous

borderline

tumor

of the ovary

  • Asymptomatic initially
  • Vaginal bleeding
  • Abdominal mass
  • Increased abdominal girth
  • Abdominal mass
  • Decreased Hb
  • Raised CEA
  • Localizes tumor
  • Demarcates the cancer
  • To visulaize the extent of the tumor
  • Large multiloculated cystic masses
  • mucus-containing cysts
  • Image guided biopsy and histopathological analysis
Metastatic

mucinous

carcinoma[4][5]

  • Ascities
  • Abdominal mass
  • Abdominal fullness
  • Early satiety
  • Fatigue
  • Bowel obstruction
  • Pleural effusion
  • Pelvic or abdominal pain
  • Venous thromboembolism
  • Bloating
  • Urinary frequency
  • Increased abdominal girth
  • Abdominal mass
  • Ascities
  • Pallor
  • Lymphadenopathy
  • Incresed CA-125
  • Decreased-Hb
  • Raised CEA
  • For the assessment for ascites and to the extent of cancer
  • Shows intra-abdominal spread
  • Shows distant metastasis and extent of the tumor
  • Mucinous differentiation
  • Tall columnar cells with apical mucin
  • Endocervical or intestinal-like appearance
  • Back-to-back cribriform glands with confluent growth pattern
  • Invasive morphology
  • Image-guided biopsy of patients with peritoneal metastasis and histopathological analysis
Mucinous

cystadenocarcinoma of pancreas

Symptoms Physical examination Lab Findings US CT MRI Histopathology Gold standard
Mucinous

cystadenoma

of pancreas[6][7][8][9][10]

  • Asymptomatic
  • Epigastric fullness
  • Abdominal mass
  • Nausea and vomiting
  • Back pain
  • Epigastric mass
  • Abdominal fullness
  • Ascities
  • Pallor
  • Lymphadenopathy
  • CEA
  • CA 19-9
  • Hb
  • EUS for evaluation of the cyst wall, may show nodules within the cyst
  • To obtain aspiration of the cyst material
  • To perform biopsy
  • CT is important for differentiating MCN from other tumors
  • Shape is smooth
  • Main pancreatic duct is not dilated
  • MRI cross-sectional images may show unilocular or multilocular cyst with a solid component
  • peripheral calcification
  • wall thickening
  • Papillary structures
  • Hypervascular pattern
  • Solitary, multilocular or unilocular cysts with a fibrotic wall and containing mucin
  • Columnar epithelium lined mucin-producing cysts with different level of dysplasia
Biopsy and histopathology
Pancreatic

pseudocyst

  • Amylase levels raised (plasma or serum)
  • Lipase levels raised (plasma)
  • US may not be a good modality of diagnoses as pancreas lies behind the stomach (and so a gas-filled stomach will obscure the pancreas
  • CT scan is the gold standard for initial assessment and follow-up
  • To establish the relationship of the pseudocyst to the pancreatic ducts
  • collection of fluid containing pancreatic enzymes, hemolysed blood and necrotic debris around the pancreas
FNA and cytology
Serous cystadenocarcinoma of pancreas[11][12][13]
  • Abdominal/flank pain
  • Weight loss
  • Per-rectal bleeding
  • Palpable mass
  • Amylase levels raised (plasma or serum)
  • Lipase levels raised (plasma)
  • US localizes the mass and shows its extent
  • CT shows well-circumscribed, multilocular masses
  • Macrocysts appear well-circumscribed with lobulations
  • Microcysts are not very visible on CT and MRI is used to locate them
  • Too see features of the primary tumor
  • Local invasion
  • Metastatic lesions
  • Microcyts appear hyperintense
  • Multiple cysts
  • Cuboidal epithelium
  • Glycogen-rich cells
  • Serous fluid
Biopsy and histopathology
Mucinous

cystadenocarcinoma of appendix

Symptoms Physical examination Lab Findings US CT MRI Histopathology Gold standard
Appendicitis

Atypical symptoms include:

  • Constant pain in the right iliac fossa
  • Prolonged diarrhea
  • Ultrasound may be helpful in the diagnosis of appendicitis
  • Findings include:
    • Noncompressible, dilated appendix
    • Appendicolith Echogenic prominent
    • Pericaecal fat and periappeniceal fluid collection
  • CT scans are preferred over ultrasounds for diagnosing appendicitis
  • Increase in appendiceal lumen with the outer-wall-to-outer-wall transverse diameter greater than 6 mm
  • Appendiceal wall thickening (wall ≥ 3mm)
    • Appendiceal wall hyperenhancement
    • Mural stratification of the appendiceal wall
  • Magnetic resonance imaging has become the common technique for diagnosing appendicitis in children and pregnant patients
  • periappendiceal stranding appears as an increased fluid signal on the T2 weighted sequence (while it is reflected by fat stranding on a CT scan)
Histopathological analysis
Mesenteric

cyst[2]

  • Asymptomatic
  • Acute or chronic abdominal pain
  • Smooth, round and mobile abdominal mass
-
  • Shows echogenic mass in appendix
  • CT scan are the best diagnostic tool
  • Provides significant information of the size and localization
  • Cystic masses associated with areas of fat necrosis and hemorrhage
  • Lymphangioma: endothelial lining
  • Enteric duplication cyst: Enteric lining and double-muscle lining with neural elements;
  • Enteric cyst: Enteric lining (mucosa with no muscle layer
  • Mesothelial cyst: mesothelial lining
  • Nonpancreatic pseudocyst has no lining, with a fibrous wall.
Enucleation and Histopathological analysis

References

  1. Ovary Epithelial tumors. Atlasgeneticsoncology (2016).http://atlasgeneticsoncology.org/Tumors/OvaryEpithTumID5230.html Accessed on February 29, 2016
  2. 2.0 2.1 Hamilton DL, Stormont JM (1989). "The volcano sign of appendiceal mucocele". Gastrointest. Endosc. 35 (5): 453–6. PMID 2792684.
  3. Raijman I, Leong S, Hassaram S, Marcon NE (March 1994). "Appendiceal mucocele: endoscopic appearance". Endoscopy. 26 (3): 326–8. doi:10.1055/s-2007-1008979. PMID 8076556.
  4. Hewitt MJ, Anderson K, Hall GD, Weston M, Hutson R, Wilkinson N, Perren TJ, Lane G, Spencer JA (January 2007). "Women with peritoneal carcinomatosis of unknown origin: Efficacy of image-guided biopsy to determine site-specific diagnosis". BJOG. 114 (1): 46–50. doi:10.1111/j.1471-0528.2006.01176.x. PMID 17233859.
  5. Reid MD, Choi HJ, Memis B, Krasinskas AM, Jang KT, Akkas G, Maithel SK, Sarmiento JM, Kooby DA, Basturk O, Adsay V (December 2015). "Serous Neoplasms of the Pancreas: A Clinicopathologic Analysis of 193 Cases and Literature Review With New Insights on Macrocystic and Solid Variants and Critical Reappraisal of So-called "Serous Cystadenocarcinoma"". Am. J. Surg. Pathol. 39 (12): 1597–610. doi:10.1097/PAS.0000000000000559. PMID 26559376.
  6. Campbell F, Azadeh B (April 2008). "Cystic neoplasms of the exocrine pancreas". Histopathology. 52 (5): 539–51. doi:10.1111/j.1365-2559.2007.02856.x. PMID 17903202.
  7. Garcea G, Ong SL, Rajesh A, Neal CP, Pollard CA, Berry DP, Dennison AR (2008). "Cystic lesions of the pancreas. A diagnostic and management dilemma". Pancreatology. 8 (3): 236–51. doi:10.1159/000134279. PMID 18497542.
  8. Sarr MG, Carpenter HA, Prabhakar LP, Orchard TF, Hughes S, van Heerden JA, DiMagno EP (February 2000). "Clinical and pathologic correlation of 84 mucinous cystic neoplasms of the pancreas: can one reliably differentiate benign from malignant (or premalignant) neoplasms?". Ann. Surg. 231 (2): 205–12. PMC 1420988. PMID 10674612.
  9. Zamboni G, Scarpa A, Bogina G, Iacono C, Bassi C, Talamini G, Sessa F, Capella C, Solcia E, Rickaert F, Mariuzzi GM, Klöppel G (April 1999). "Mucinous cystic tumors of the pancreas: clinicopathological features, prognosis, and relationship to other mucinous cystic tumors". Am. J. Surg. Pathol. 23 (4): 410–22. PMID 10199470.
  10. Testini M, Gurrado A, Lissidini G, Venezia P, Greco L, Piccinni G (December 2010). "Management of mucinous cystic neoplasms of the pancreas". World J. Gastroenterol. 16 (45): 5682–92. PMC 2997983. PMID 21128317.
  11. Huh J, Byun JH, Hong SM, Kim KW, Kim JH, Lee SS, Kim HJ, Lee MG (August 2016). "Malignant pancreatic serous cystic neoplasms: systematic review with a new case". BMC Gastroenterol. 16 (1): 97. doi:10.1186/s12876-016-0518-0. PMC 4994257. PMID 27549181.
  12. Reid MD, Choi HJ, Memis B, Krasinskas AM, Jang KT, Akkas G, Maithel SK, Sarmiento JM, Kooby DA, Basturk O, Adsay V (December 2015). "Serous Neoplasms of the Pancreas: A Clinicopathologic Analysis of 193 Cases and Literature Review With New Insights on Macrocystic and Solid Variants and Critical Reappraisal of So-called "Serous Cystadenocarcinoma"". Am. J. Surg. Pathol. 39 (12): 1597–610. doi:10.1097/PAS.0000000000000559. PMID 26559376.
  13. Reid MD, Choi HJ, Memis B, Krasinskas AM, Jang KT, Akkas G, Maithel SK, Sarmiento JM, Kooby DA, Basturk O, Adsay V (December 2015). "Serous Neoplasms of the Pancreas: A Clinicopathologic Analysis of 193 Cases and Literature Review With New Insights on Macrocystic and Solid Variants and Critical Reappraisal of So-called "Serous Cystadenocarcinoma"". Am. J. Surg. Pathol. 39 (12): 1597–610. doi:10.1097/PAS.0000000000000559. PMID 26559376.
  14. Yelon, Jay A. & Luchette, Fred A. (2014), Geriatric Trauma and Critical Care (1st ed.), New York, New York: Springer

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