Pancreas - Mucinous non-neoplastic cyst (MNC)

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Pancreas

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Mucinous non-neoplastic cyst (MNC)

Reviewer: Deepali Jain, M.D. (see Reviewers page)
Revised: 24 November 2012, last major update August 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

General
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● Initially described in 2002 (Mod Pathol 2002;15:154)
● 10% of mucinous pancreatic cysts (Pancreas 2012;41:441)
● Men and women, mean age 57 years
● Does not recur after resection
● Appears to be nonneoplastic, polyclonal; may develop from acinar ductal mucinous metaplasia (Hum Pathol 2010;41:513)

Gross description
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● Usually unifocal, head of pancreas, thin walled cysts that don’t communicate with ductal system

Gross images
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Unilocular cyst containing chocolate-colored old blood

Unilocuar and multilocular cysts with no definitive connection to pancreatic duct

Micro description
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● Cuboidal/columnar mucin producing cells with small amount of dense fibrous stroma
● No ovarian type stroma
● No cellular atypia or increased proliferation
● No communication with duct or biliary system

Micro images
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Cysts are lined by single layer of cylindrical / cuboidal cells

Various images

Cytology description
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● Cuboidal/columnar cells in flat honeycomb sheets/nests (100%) with delicate/vacuolated (61%) cytoplasm, round/oval nuclei are small to slightly enlarged with 1-2 inconspicuous nucleoli, fine granular chromatin, smooth nuclear contour; also nuclear grooves (43.5%), nuclear pseudoinclusions (26%); usually thin mucin (Pancreas 2012 Jun 28 [Epub ahead of print])

Cytology images
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Comparison with IPMN

Positive stains
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● CK7, CK8, CK18, CK19, CK20, Ca 19-9, MUC1, MUC5AC

Negative stains
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● Trypsin, CEA, synaptophysin, chromogranin A, calretinin, alpha-inhibin, MUC1 (usually), MUC2 (negative in noplastic IPMN), progesterone receptor

Differential diagnosis
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● Mucinous cystic neoplasms: body/tail, women, atypia, ovarian-like stroma; similar epithelial lining and immunostaining

End of Pancreas > Cysts > Mucinous non-neoplastic cyst (MNC)

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