Clinical Management of Intraductal Papillary Mucinous Tumors of the Pancreas Based on Imaging Findings

Abstract

The aim of this study was to assess the imaging findings of pathologically proven intraductal papillary-mucinous tumors of the pancreas and the natural history of follow-up cases, and to optimize the therapeutic management of patients with these tumors according to their imaging findings. All nine patients with main duct type tumors were histologically diagnosed as having adenocarcinoma or adenoma, with no hyperplastic lesion. The images failed to discriminate between the two histologic types. In 26 patients with branch duct type tumors, all but one with intraductal mural nodules or tumors of > or = 30 mm had adenocarcinoma or adenoma, regardless of the caliber of the main duct. Of the nine patients with tumors < 30 mm and no mural nodules. three had adenoma, and six had hyperplasia. All of four patients had hyperplasia, with the additional caliber of the main duct being < 6 mm. In a series of 23 cases in which the patient was followed-up, no apparent progression was found in 17 patients who had no mural nodules and tumors of < 30 mm. Given these results, patients with main duct type tumors, and those with branch duct type tumors showing mural nodules or a tumor diameter of > or = 30 mm, are at high risk of developing neoplasms, including adenocarcinoma, for which surgical resection should be considered, whereas those patients with tumors < 30 mm and no mural nodules can be followed.

Multicenter Analysis of Clinicopathologic Features of Intraductal Papillary Mucinous Tumor of the Pancreas: Is It Possible to Predict the Malignancy Before Surgery?

“…A combination of peroral pancreatoscopy and intraductal ultrasonography resulted in a considerably improved differential diagnosis of malignant and benign IPMT and was useful for determining an effective therapeutic approach. 11,12 Recently some reports have encouraged the establishment of molecular diagnosis by using K-ras, p53, p16(INK4A), Smad4, telomerase activity, and the expression of MUC1. [13][14][15][16][17][18] However, these techniques are not yet practically useful.…”

International Consensus Guidelines for Management of Intraductal Papillary Mucinous Neoplasms and Mucinous Cystic Neoplasms of the Pancreas

“…There are few reports in the English literature on identifying predictors of malignancy in asymptomatic mucinous lesions [22] . There have been four reports in the English literature describing the natural history of pancreatic IPMN evaluated by ERCP, CT or MRCP [81][82][83][84] .…”

Treatment Strategy for Intraductal Papillary Mucinous Neoplasm of the Pancreas Based on Malignant Predictive Factors

“…Some researchers have reported that resection should be performed whenever IPMNs are diagnosed, even if they are considered to be benign by the imaging findings, 10 whereas others reported that no enlargement of the IPMNs occurred during several years of follow-up 19,20 and longterm survival could be expected in some patients without a resection. 21 Our results suggest that benign IPMNs should be strictly followed up without resection because IPMNs generally progress slowly, occur in elderly patients, and sometimes occur multifocally, thus leading to an extensive resection and higher postoperative morbidity.…”