Intraductal Papillary Mucinous Neoplasm of the Pancreas: Understanding the Basics and Beyond

Abstract

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.

New-onset diabetes as clinical presentation of invasive intraductal papillary mucinous neoplasm of the pancreas

“…7 When symptoms appear, they are often non-specific, like fatigue and weight loss, and overlap with other pancreatic and biliary tree diseases. 8 This is often due to mucin hypersecretion that can lead to mucus impaction in the pancreatic ducts and consequent obstruction of pancreatic drainage. 9 The principal symptoms are abdominal pain, recurrent acute pancreatitis, jaundice, onset or worsening of diabetes and steatorrhea.…”

“…10 IPMN diagnosis can be made using radiologic findings, endoscopic visualization, tumour markers and cytologic/histologic evaluation. 8 Abdominal CT scan is the most widely used radiologic modality, although magnetic resonance imaging, combined with magnetic resonance cholangiopancreatography (MRI/ MRCP), is the modality of choice, because of its superiority in cyst characterization. 11 Endoscopic ultrasound has an added benefit that it allows cyst fluid collection with fine-needle aspiration for cytological analysis, which is indicated in case of indefinite imaging findings.…”

The Diverse Involvement of Cigarette Smoking in Pancreatic Cancer Development and Prognosis

“…41 Although intraductal papillary mucinous neoplasms (IPMNs) are benign and make up only approximately 20% of the cystic lesions of the pancreas, they are the most extensively studied that this is secondary to their innate ability to transform into malignant lesions. 42 In addition, the development and recent advances in endoscopic ultrasonography have largely influenced our understanding of IPMN and its subsequent risk for PDAC development. Intraductal papillary mucinous neoplasm with high-grade dysplasia has been shown to increase the risk of the subsequent development of PDAC.…”

Case report: Treatment of intraductal papillary mucinous neoplasms located in middle-segment pancreas with end-to-end anastomosis reconstruction after laparoscopic central pancreatectomy surgery through a pigtail-tube-stent placement of the pancreatic duct

“…It was first reported in the late 1970s. With improvements in radiographic and endoscopic imaging techniques, IPMN represents approximately 1% of all pancreatic neoplasms ( 1 , 2 ). IPMNs are divided into three types: main duct-IPMN (MD-IPMN), branch duct-IPMN (BD-IPMN), and mixed type-IPMN (MT-IPMN) based on imaging studies and/or histology ( 3 ).…”