Optimal Management of the Branch Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas

Matsumoto, Toshifumi; Aramaki, Masanori; Yada, Kazuhiro; Hirano, Seitaro; Himeno, Y; Shibata, Kohei; Kawano, Katsunori; Kitano, Seigo

doi:10.1097/00004836-200303000-00014

Cited by 202 publications

(119 citation statements)

References 25 publications

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“…The data in this study also complied with this rule. However, compared with the published series from Europe, Japan, and the USA [9,[29][30][31][32] , the main duct IPMN had a lower rate of malignancy (1 of 3) in the present study, whereas the combined-type IPMNs demonstrated malignancy in more cases (10 of 12) on pathology. The sensitivity, specificity, and accuracy of MDCT in characterizing the malignancy of IPMNs were 100%, 87.5% and 95%, respectively.…”

Section: Discussioncontrasting

confidence: 80%

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

Tan

Ya-e²,

Wang³

et al. 2009

WJG

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AIM:To retrospectively evaluate the imaging features of pancreatic intraductal papillary mucinous neoplasms (IPMNs) in multi-detector row computed tomography (MDCT). METHODS:A total of 20 patients with pathologicallyconfirmed intraductal papillary mucinous neoplasms (IPMNs) were included in this study. Axial MDCT images combined with CT angiography (CTA) and multiplanar volume reformations (MPVR) or curved reformations (CR) were preoperatively acquired. Two radiologists (Tan L and Wang DB) reviewed all the images in consensus using an interactive picture archiving and communication system. The disputes in readings were resolved through consultation with a third experienced radiologist (Chen KM). Finally, the findings and diagnoses were compared with the pathologic results. RESULTS:The pathological study revealed 12 malignant IPMNs and eight benign IPMNs. The diameters of the cystic lesions and main pancreatic ducts (MPDs) were significantly larger in malignant IPMNs compared with those of the benign IPMNs (P < 0.05). The combinedtype IPMNs had a higher rate of malignancy than the other two types of IPMNs (P < 0.05). Tumors with mural nodules and thick septa had a significantly higher incidence of malignancy than tumors without these features (P < 0.05). Communication of side-branch IPMNs with the MPD was present in nine cases at pathologic examination. Seven of them were identified from CTA and MPVR or CR images. From comparison with the pathological diagnosis, the sensitivity, specificity, and accuracy of MDCT in characterizing the malignancy of IPMN of the pancreas were determined to be 100%, 87.5% and 95%, respectively.

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Section: Discussioncontrasting

confidence: 80%

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

Tan

Ya-e²,

Wang³

et al. 2009

WJG

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“…This in turn raises the question of whether branch-duct IPMN (Br-IPMNs) may be a distinct tumor type with altogether different biologic behavior than those arising in the main pancreatic duct. [5][6][7][8][9] Various reports have shown significant differences in the prevalence of cancer in main-duct IPMN (including the mixed type) vs Br-IPMNs (70% vs 25%, respectively). 1,[3][4][5][7][8][9][10][11][12][13] Consequently, some authors have recommended nonsurgical management with close observation for IPMNs that arise from branch ducts and that fail to meet certain "high-risk" criteria.…”

mentioning

confidence: 99%

Branch-Duct Intraductal Papillary Mucinous Neoplasms: Observations in 145 Patients Who Underwent Resection

et al. 2007

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“…Vari studi dimostrano infatti come nelle IPMN dei dotti principali la progressione verso forme maligne, in situ o invasive, avvenga in una percentuale variabile dal 60% al 92%, con una media del 70%. Sulla base di tali dati, qualora le indagini preoperatorie pongano il sospetto di una IPMN del dotto principale o di tipo misto, l' exeresi chirurgica è di regola indicata [10,11,[14][15][16][17][18][19][20].…”

Section: Figura 1 Immagini Rm/tc Della Lesione Cistica Mucinosa Intrunclassified

“…Decisamente meno frequente è la cancerizzazione delle lesioni interessanti i dotti periferici, riscontrata in una percentuale variabile dal 6% al 46%, con una media del 25% [10,11,[14][15][16][17][18][19]. È da notare, però, come i due studi che descrivono la più alta frequenza di cancro invasivo (30% e 31% rispettiSulla base del referto della TC la paziente è stata sottoposta a colangio-RM (Figura 1).…”

Section: Figura 1 Immagini Rm/tc Della Lesione Cistica Mucinosa Intrunclassified

Main-duct intraductal papillary mucinous neoplasm of the pancreas: a case report

Manetti

Faini

Bucciero

et al. 2012

CMI

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INTRODUZIONELe neoplasie mucinose cistiche del pancreas possono essere classificate in due gruppi ben distinti: neoplasie papillari mucinose intraduttali (IPMN) e neoplasie mucinose cistiche (MCN) (Tabella I).Queste ultime sono maligne o potenzialmente tali anche se con una crescita molto lenta rispetto alle IPMN [2]. Spesso interessano donne di mezza età e la sintomatologia di esordio consiste principalmente in dolore addominale e presenza di una massa palpabile in epigastrio. Sono solitamente localizzate nella coda del pancreas e sono costituite da cisti mucinose uniloculari o multiloculari ben circoscritte con dimensioni medie di 7-10 cm [3,4] Caso clinico AbstractThree distinct entities among non-inflammatory cystic lesions of the pancreas have been defined: intraductal papillary mucinous neoplasm (IPMN), serous cystic neoplasm (SCN) and mucinous cystic neoplasm (MCN). IPMN is characterized by intraductal papillary growth and thick mucus secretion: its incidence has dramatically increased since its initial description. These lesions probably can progress towards invasive carcinoma. IPMNs are symptomatic in most cases: the typical presentation is a recurrent acute pancreatitis, without evident cause, of low or moderate severity. The diagnosis is usually based upon the imaging (CT/cholangio-MRI) demonstrating a pancreatic cystic mass, involving a dilated main duct, eventually associated to some filling defects, or a normal Wirsung duct communicating with the cyst lesion. Surgical treatment is generally indicated for main duct IPMN and branch duct IPMN with suspected malignancy (tumour size ≥ 30 mm, mural nodules, dilated main pancreatic duct, or positive cytology) or prominent symptoms. Herein we present a case of IPMN of the main duct which occurred with abdominal and back pain associated with weight loss. After the diagnosis, she successfully underwent surgery and is now in a follow-up program.

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Optimal Management of the Branch Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas

Abstract: These results suggest that the branch duct type IPMNs less than 30 mm and without mural nodules is benign and might be treatable with limited resection or careful observation.

Cited by 202 publications

References 25 publications

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

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

Branch-Duct Intraductal Papillary Mucinous Neoplasms: Observations in 145 Patients Who Underwent Resection

Main-duct intraductal papillary mucinous neoplasm of the pancreas: a case report

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