Clinicopathologic analysis of surgically proven intraductal papillary mucinous neoplasms of the pancreas in SNUH: a 15-year experience at a single academic institution

Abstract

Purpose The clinical importance of intraductal papillary mucinous neoplasm of the pancreas (IPMN) has been increasing with a large number of newly diagnosed IPMN. This study was designed to explore the characteristics of resected IPMN and to determine the predictive factors for malignant and invasive IPMN. Methods Retrospective review of a prospectively collected database was performed on 187 consecutive patients following IPMN surgery between 1994 and 2008 at a tertiary institute. The main duct type IPMN was radiologically defined as main pancreatic duct dilation >5 mm rather than previously defined ≥10 mm. Results The morphologic types of IPMN included 28 main duct (IPMN-M, 15.0%), 118 branch duct (IPMN-Br, 63.1%), and 41 mixed (IPMN-Mixed, 21.9%) IPMNs. There were 23 patients with adenoma, 106 borderline atypia, 15 carcinoma in situ, and 43 invasive carcinoma. Sixty-nine extrapancreatic malignancies were diagnosed in 61 (32.6%) patients. Based on multivariate analysis, IPMN-M was statistically significant predictor of malignancy/ invasiveness (p=0.013/p=0.028). In patients with IPMNBr, the presence of mural nodule was a predictive factor for malignancy/invasiveness (p=0.005/p=0.002). In patients with IPMN-Mixed, mural nodule (p=0.038/p=0.047) and wall thickening (>2 mm, p=0.015/p=0.046) were risk factor for malignancy/invasiveness and elevated CA19-9 (p=0.046) for invasiveness. Conclusions The main pancreatic duct diameter (>5 mm) is a significant predictor for malignancy and invasiveness. Therefore, IPMN patients with main pancreatic duct dilatation (>5 mm) should be considered surgical resection. Mural nodule is the indicator of surgery in IPMN-Br and IPMN-Mixed. In case of IPMN-Mixed with wall thickening or elevated serum CA19-9, surgical resection is recommended.

Intraductal papillary mucinous neoplasm

“…The reported mean age at diagnosis varies from 63 to 66 years [8][9][10][11][12][13]. Patients with an IPMN with an associated invasive carcinoma are generally 3 to 5 years older than those with noninvasive IPMNs, suggesting that it takes years for an IPMN to progress to invasive cancer [10,12,14].…”

“…Common presenting symptoms include abdominal pain, back pain, nausea, vomiting and weight loss [10,12,13,18,19]. Over time, some patients develop pancreatic insufficiency including steatorrhea and diabetes mellitus.…”

Intraductal Papillary Mucinous Neoplasms of the Pancreas: Challenges and New Insights

“…Challenges in Pancreatic Pathology riskofmalignancy.Eveninthefaceofanegativecytology,ifEUSandMRIconfirmhigh-risk stigmata,thespecificityislikelytobehigh.However,nocurrentlyavailabledatacandemonstratetheimpactofmultiplehigh-riskfeatures.Moleculartechniquestoevaluatepancreatic cysts remain an emerging area of research [23,49,50],buthadthebenefitsofsurgeryoutweightherisksinthisselectedpopulation [51].…”

CT and MR imaging features of fistulas from intraductal papillary mucinous neoplasms of the pancreas to adjacent organs: A retrospective study of 423 patients

“…Des kystes à parois fines à contenu généralement homogène, localisés plus souvent dans le processus unciné, ronds ou ovoïdes, parfois lobulés en « grappe de raisin » peuvent être mis (27,28,32,37,38,41,49,55,56). Les parois du canal de Wirsung sont le plus souvent régulières, les bords du canal dilaté restant parallèles, sans l'aspect moniliforme observé dans la pancréatite chronique.…”