Intraductal papillary mucinous neoplasm (IPMN) is a benign cystic lesion that grows in the pancreatic ductal system. While the risk for undergoing malignant transformation is dependent on a number of factors, the risk is certainly present, differentiating it from other cystic lesions of the pancreas. Additionally, IMPN is to be starkly contrasted with adenocarcinoma of the pancreas, which is by nature malignant. There are numerous ways to detect IPMN, which is helpful, as a patient may be initially asymptomatic at presentation. Prognosis varies depending upon the malignant potential of the lesion at hand. Surgical resection is the mainstay of treatment in patients with a high probability of malignancy potential. What once was a very confusing diagnosis is now becoming defined based on new literature. The goal of this manuscript is to compile the literature on IPMNs in a clear and precise way as to educate clinicians as to the nature of this increasingly prevalent disease.
Extra-intestinal manifestations are frequent complications of the classical inflammatory bowel diseases, Crohn’s disease and ulcerative colitis. However, in addition to the classical diseases, there is a spectrum of conditions, often termed “microscopic colitis”, in which extra-intestinal manifestations are less well described. Our objective was to review the literature regarding the extra-intestinal manifestations complicating microscopic colitis and describe the association with systemic autoimmune rheumatic diseases. A comprehensive search and review of peer-reviewed English-language and international journals and reports was completed based on key terms, including “microscopic colitis”, “lymphocytic colitis”, “collagenous colitis”, “inflammatory bowel disease”, “extraintestinal manifestations”, and the specific disease associations utilizing the PubMed Central database and MEDLINE. A broad spectrum of rheumatologic manifestations has been reported in patients with microscopic colitis. The identification of rheumatoid arthritis and limited scleroderma as co-morbidities with microscopic colitis was noteworthy. Inflammatory arthropathy was frequently seen in microscopic colitis, usually preceding or occurring in conjunction with the onset of gastrointestinal symptoms. A variety of presentations of associated arthritis were reported: migratory, symmetric or asymmetric, peripheral or axial, oligoarticular or polyarticular, erosive or non-erosive. There was a high incidence of autoantibodies in these patients, supporting a potential autoimmune association. On the basis of these anecdotal reports, we would suggest development of a clinical registry to help define the incidence of extra-intestinal manifestations and systemic autoimmune rheumatic diseases among microscopic colitis patients to help elucidate shared predispositions, pathogenic mechanisms and therapeutic opportunities.
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