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

Kalaitzakis, Evangelos; Braden, Barbara; Trivedi, Palak; Sharifi, Yalda; Chapman, Roger W.

doi:10.3748/wjg.15.1273

Cited by 22 publications

(13 citation statements)

References 9 publications

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“…Several mechanisms that might explain the occurrence of pancreatic calcification in patients with IPMN have been suggested. One possible mechanism is that the blocking of the pancreatic duct by a mucin plug might be responsible for the formation of pancreatic calcification . Intestinal type IPMN has been reported to belong to the hypermucin secretion type.…”

Section: Discussionmentioning

confidence: 99%

“…One possible mechanism is that the blocking of the pancreatic duct by a mucin plug might be responsible for the formation of pancreatic calcification. 12,18 Intestinal type IPMN has been reported to belong to the hypermucin secretion type. Therefore, we hypothesized that the intestinal type might be related to pancreatic calcification, but no significant association was detected between the mucin phenotype and pancreatic 0.0002 0.001 0.006 † The scores shown were awarded as follows: 0 (absent) and 1+ (present).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Significance of pancreatic calcification on preoperative computed tomography of intraductal papillary mucinous neoplasms

Tsujimae

Masuda

Shiomi

et al. 2019

J of Gastro and Hepatol

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Background and Aim Chronic pancreatitis is a risk factor for pancreatic cancer. Pancreatic calcification is a characteristic of chronic pancreatitis; however, its significance for intraductal papillary mucinous neoplasm (IPMN) oncogenesis remains unknown. Therefore, we investigated the relationship between pancreatic calcification and invasive IPMN. Methods This study included 157 patients who underwent resection for IPMN between April 2001 and October 2016 (intraductal papillary mucinous adenoma, n = 76; noninvasive intraductal papillary mucinous carcinoma [IPMC], n = 32; and invasive IPMC, n = 49). We divided the subjects on the basis of the presence/absence of pancreatic calcification on preoperative computed tomography (CT). The factors associated with pancreatic calcification were investigated in univariate analyses. Then, multivariate logistic regression analyses of the relationship between pancreatic calcification and invasive IPMC (after adjusting for clinical or imaging characteristics) were conducted. Results Preoperative CT revealed pancreatic calcification in 17.2% (27/157) of the resected IPMN. In the univariate analyses, jaundice, high serum carbohydrate antigen 19‐9 levels, and invasive IPMC were significantly associated with pancreatic calcification (4/27 [14.8%] vs 4/130 [3.1%], 0.01; 12/27 [44.4%] vs 31/130 [23.8%], 0.03; and 15/27 [55.6%] vs 34/130 [26.2%], 0.001, respectively). Pancreatic calcification was significantly associated with invasive IPMC (multivariate odds ratio = 2.88, 95% confidence interval [95% CI] = 1.15–7.21, 0.03, adjusted for clinical characteristics; odds ratio = 5.50, 95% CI = 1.98–15.3, 0.001, adjusted for imaging characteristics). Conclusions Pancreatic calcification on CT is associated with invasive IPMC. Pancreatic calcification might be a predictor of invasive IPMC.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Significance of pancreatic calcification on preoperative computed tomography of intraductal papillary mucinous neoplasms

Tsujimae

Masuda

Shiomi

et al. 2019

J of Gastro and Hepatol

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“…In our series, four of five cases have the similar appearance. Additionally, calcification was also observed in CCs, and the most likely explanation for the calcification in CCs is the presence of thick mucin, which has the tendency to build up calcium salt deposits ( 19 , 20 ).…”

Section: Discussionmentioning

confidence: 99%

Assessment of pancreatic colloid carcinoma using 18F‑FDG PET/CT compared with MRI and enhanced CT

et al. 2018

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Pancreatic colloid carcinoma (CC) is a rare sub-type of pancreatic adenocarcinoma which has an improved prognosis compared with pancreatic ductal carcinoma. Consequently, the early detection of CC by imaging may be of great significance in guiding patient management and therapeutic decisions. The present study aimed to analyze 18F-FDG PET/CT findings of CC in comparison to MRI and CT. PET/CT findings in 5 patients with CC were retrospectively reviewed based on visual interpretation and semi-quantitative index of SUVmax and TNR. Four patients received dual-time-point PET/CT scans. Additionally, one patient underwent contrast-enhanced CT scan, one MRI, and three received both. A total of five lesions were detected in five patients. Visually, two cases presented with mild FDG uptake, two with moderate and one with high. The mean of SUVmax and TNR was 5.1±2.2 and 2.8±0.7, respectively. Compared with CCs with low SUVmax, CCs with high SUVmax were more aggressive. No distant metastases were observed in five cases. Among four patients with dual-time-point PET/CT imaging, SUVmax increased in three cases and decreased in one case. The mean early and delayed SUVmax were 4.2±1.1 and 4.7±1.9, respectively (P>0.05). Radiological findings mainly included septated cystic components, internal sponge-like contrast-enhancement, calcification and ‘salt-and-pepper sign’ on MRI T2-weighted imaging. Thus, PET/CT provided additional information on metabolic tumor activity as well as locoregional and distant staging, which are important prognostic markers and may improve further patient management. However, PET/CT did not show any findings in addition to MRI and contrast-enhanced CT that were unique to CC and allowed a clear differentiation from other pancreatic malignancies.

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“…Mucin has usually the same pattern of pancreatic juice with the different imaging techniques (hypoechoic at US, hypodense at CT, hyperintense on T2-weighted images, and hypointense on T1-weighted images at MRI), thus it is not possible to differentiate mucin from pancreatic juice. Although some authors suggested that with DWI is possible to differentiate the content of cystic lesions of the pancreas [75], there is a significant overlap in ADC values between pancreatic juice, IPMN, serous cystadenoma (SCA), and mucinous cystadenoma.…”

Section: Imaging-pathologic Correlationmentioning

confidence: 99%

“…Extensive pancreatic calcifications are generally thought to be a sign of chronic pancreatitis, but it may occur simultaneously with IPMN leading to diagnostic difficulties [75].…”

Section: Pitfalls and Errorsmentioning

confidence: 99%

Intraductal Papillary Mucinous Neoplasm (IPMN)

Morana

D’Onofrio²,

Martini³

et al. 2014

Imaging and Pathology of Pancreatic Neoplasms

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PathologyIntraductal neoplasms of the pancreas are cystic or mass-forming epithelial tumors with ductal differentiation, that typically grow primarily within the ductal system [14]. Two main groups have been defined: intraductal papillary mucinous neoplasms (IPMNs) and intraductal tubulopapillary neoplasms (ITPNs).Epithelial morphology and mucin expression patterns define four main histologic subtypes of IPMN [15]: intestinal, gastric, oncocytic, and pancreaticobiliary. Recent papers support the hypothesis of distinct pathways for carcinogenesis among the different IPMN subtypes [16,17].IPMNs are defined as an intraductal grossly visible (typically >1 cm, a threshold useful to distinguish IPMNs from PanINs) epithelial neoplasm made up of mucin-producing cells, arising in pancreatic ductal system [14].

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

Cited by 22 publications

References 9 publications

Significance of pancreatic calcification on preoperative computed tomography of intraductal papillary mucinous neoplasms

Significance of pancreatic calcification on preoperative computed tomography of intraductal papillary mucinous neoplasms

Assessment of pancreatic colloid carcinoma using 18F‑FDG PET/CT compared with MRI and enhanced CT

Intraductal Papillary Mucinous Neoplasm (IPMN)

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