Intraductal papillary mucinous neoplasms and other pancreatic cystic lesions

Abstract

Pancreatic cystic neoplasms are being increasingly recognized, even in the absence of symptoms, in large part, due to markedly improved imaging modalities such as magnetic resonance imaging (MRI)/magnetic resonance cholangio pancreatography (MRCP) and computer tomography (CT) scanning. During the past 2 decades, better imaging of these cystic lesions has resulted in definition of different types, including pancreatic intraductal papillary mucinous neoplasms ( I P M N ) . W h i l e I P M N r e p r e s e n t o n l y a d i s t i n c t minority of all pancreatic cancers, they appear to be a relatively frequent neoplastic form of pancreatic cystic neoplasm. Moreover, IPMN have a much better outcome and prognosis compared to pancreatic ductal adenocarcinomas. Therefore, recognition of this entity is exceedingly important for the clinician involved in diagnosis and further evaluation of a potentially curable form of pancreatic cancer.

Contrast‐enhanced ultrasound of pancreatic tumours

“…International consensus guidelines 56 recommend resection in presence of high‐risk stigmata, while in presence of “worrisome features” the lesion should be evaluated by EUS to further risk‐stratify the lesion. Most IPMNs are asymptomatic and incidentally found during clinical evaluation for other conditions; when symptoms occur, they are generally related to intermittent obstruction of the pancreatic duct caused by thick mucin produced by the neoplasm 59 …”

Imaging features of intraductal papillary mucinous neoplasms of the pancreas in multi-detector row computed tomography

“…The overall 5-year survival rate has been reported to exceed 80% for noninvasive IPMNs and 50% for the invasive malignant IPMNs [19] . Therefore, correct evaluation of IPMN is extremely important as a recent analysis has suggested that this entity is one of the few surgically curable pancreatic neoplasms [18] .…”

“…After the first report of IPMN in 1982, this tumor entity has been increasingly recognized over the past decades as a result of the markedly improved imaging modalities [18,19] . IPMNs mainly occur in the 6th to 7th decades of life, affecting males slightly more frequently than females.…”

“…The IPMN was histologically defined by the WHO as "intraductal mucin-producing neoplasm with tall columnar mucin-containing epithelium with or without papillary projections, involving the MPD and/or major side branches" [21] . The IPMN is also believed by some to follow the so-called "adenoma-carcinoma" sequence [19] . Sohn et al [22] reported that there appears to be a lag time of approximately 5 years in the progression from adenoma to invasive carcinoma and that progression to invasive carcinoma occurs relatively quickly once moderate dysplasia is found.…”

Intraductal papillary mucinous neoplasm in chronic calcifying pancreatitis: Egg or hen?

“…Intraductal papillary mucinous neoplasm (IPMN) is an increasingly reported entity, representing up to one third of all pancreatic cystic neoplasms [1] . IPMNs typically present with cystic dilatation of the pancreatic duct associated with mucin production and variable cellular atypia.…”