Intraductal papillary mucinous neoplasm

Shi, Chanjuan; Hruban, Ralph H.

doi:10.1016/j.humpath.2011.04.003

Cited by 112 publications

(112 citation statements)

References 130 publications

(276 reference statements)

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“…Patients are often asymptomatic, but may experience symptoms related to obstruction of the pancreatic ductal system such as abdominal pain, weight loss and recurrent episodes of pancreatitis [5] . The rate of diagnosis for asymptomatic, incidentally discovered IPMN is currently increasing due to the improving resolution and expanded utilization of high-quality cross-sectional imaging.…”

Section: Clinicopathological Features Of Ipmnmentioning

confidence: 99%

“…They are categorized into 3 morphological types based on location of involvement derived from imaging studies and/or histology: main duct IPMN (MD-IPMN), branch duct IPMN (BD-IPMN) and mixed-type IPMN (MT-IPMN) [1,5,7] . Main duct involvement is associated with the highest rates of invasive disease, which are reported to be 43.1 and 45.3% for MD-and MT-IPMN, respectively.…”

Section: Clinicopathological Features Of Ipmnmentioning

confidence: 99%

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Is It Time to Expand the Role of Total Pancreatectomy for IPMN?

Griffin

Poruk

Wolfgang³

2016

Dig Surg

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Intraductal papillary mucinous neoplasms (IPMN) are cystic precursors to pancreatic cancer believed to arise within a widespread neoplastic field defect. The tendency for some patients to present with multifocal disease and/or develop additional lesions over time argues in favor of a field defect and complicates surgical management decisions. Surgery usually consists of partial pancreatic resection, which leaves behind a pancreatic remnant at risk for recurrent disease and progression to cancer. As an alternative, total pancreatectomy (TP) provides the most complete oncologic resection, but postoperative morbidity and quality of life (QoL) issues have generally limited its use to only the highest risk patients. Significant progress has been made in the management of the post-TP apancreatic state and studies now show less morbidity with acceptable QoL comparable to type 1 diabetic and post-pancreaticoduodenectomy patients. These improvements do not yet justify the routine use of TP, but they have opened the door for expansion to additional subsets of non-invasive IPMN. Here, we have identified several groups of patients that we believe would benefit from TP over partial resection based on the most current literature.

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Section: Clinicopathological Features Of Ipmnmentioning

confidence: 99%

Section: Clinicopathological Features Of Ipmnmentioning

confidence: 99%

Is It Time to Expand the Role of Total Pancreatectomy for IPMN?

Griffin

Poruk

Wolfgang³

2016

Dig Surg

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“…Mucin-containing intraepithelial and intracellular lumina, as well as scattered goblet cells, may be seen (Figure 4, B). 42,43 These neoplasms show diffuse high-grade dysplasia and may evolve into invasive carcinoma with similar oncocytic features. Intraductal oncocytic papillary neoplasms are typically positive for MUC6 (Figure 4, C) and MUC1, may be focally positive for MUC5AC, and are usually negative for MUC2 and CDX2, except in interspersed goblet cells.…”

Section: Intraductal Oncocytic Papillary Neoplasmmentioning

confidence: 99%

“…Intraductal oncocytic papillary neoplasms are typically positive for MUC6 (Figure 4, C) and MUC1, may be focally positive for MUC5AC, and are usually negative for MUC2 and CDX2, except in interspersed goblet cells. 43,44 Intraductal oncocytic papillary neoplasms characteristically lack the KRAS mutations that are found in PDAC and many nononcocytic IPMNs. 45,46 Intraductal Tubulopapillary Neoplasm Intraductal tubulopapillary neoplasms are relatively rare, making up approximately 3% of the intraductal neoplasms of the pancreas, and they are clinically and histopathologically distinct from IPMNs.…”

Section: Intraductal Oncocytic Papillary Neoplasmmentioning

confidence: 99%

Difficult Diagnostic Problems in Pancreatobiliary Neoplasia

Bledsoe¹,

Shinagare²

2015

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Many common diagnostic dilemmas are encountered in pancreatobiliary pathology, frequently resulting in uncertainty on behalf of the pathologist and referral for a second opinion.Objectives.-To review 4 common diagnostic dilemmas encountered in the practice of pancreatobiliary pathology: (1) pancreatic ductal adenocarcinoma versus chronic pancreatitis; (2) pancreatic ductal carcinoma versus adenocarcinomas arising in the ampulla and intrapancreatic common bile duct; (3) the distinction of uncommon intraductal neoplasms-intraductal oncocytic papillary neoplasm, intraductal tubulopapillary neoplasm, and intraductal acinar cell carcinoma; and (4) intrahepatic cholangiocarcinoma versus metastatic carcinoma.Data Sources.-A review of pertinent literature, along with the authors' personal experience, based on institutional and consultation materials.Conclusions.-Important diagnostic features for a few challenging problems in pancreatobiliary pathology are reviewed. Careful study of the microscopic features along with awareness of differential diagnoses and diagnostic pitfalls generally allows distinction of these entities. We also highlight established and novel ancillary studies that help to arrive at an accurate diagnosis.

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“…The latter neoplasms can progress from a benign and non-invasive adenoma with mild dysplasia through stages with increasing grades of dysplasia and eventually transform into invasive cancer [3] . For this reason, PCNs, and in particular IPMNs, offer today an extraordinary opportunity to detect pancreatic cancer progression and perform preemptive pancreatic surgery [4] .…”

Section: Editorialmentioning

confidence: 99%

Cystic tumors of the pancreas: Opportunities and risks

Chiaro

Verbeke

2015

WJGP

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neoplasms of the pancreas can be considered as the pancreatic analogon to colonic polyps. Treatment of these precursor lesions at an early stage can potentially reduce pancreas cancer mortality and introduce a new "era" of preemptive pancreatic surgery. However, only few of those lesions have an aggressive behavior. The accuracy of preoperative diagnosis, i.e. , the distinction between the various PCNs is around 60%, and the ability to predict the future outcome is also less accurate. For this reason, a significant number of patients are currently over-treated with an unnecessary, high-risk surgery. Furthermore, the majority of patients with PCN are on life-long follow-up with imaging modality, which has huge cost implications for the Health Care System for limited benefits considering that a significant proportion of PCNs are or behave like benign lesions. The current guidelines for the diagnosis and management of PCNs are more based on expert opinion than on evidence. For all those reasons, the management of cystic tumors of the pancreas remains a controversial area of pancreatology. On one hand, the detection of PCNs and the surgical treatment of pre-cancerous neoplasms can be considered a big opportunity to reduce pancreatic cancer related mortality. On the other hand, PCNs are associated with a considerable risk of under-or over-treatment of patients and incur high costs for the Health Care System. Core tip: The present paper is an editorial focused on the critical problems regarding the management strategy of pancreatic cystic neoplasms (PCNs). Being a pre-cancerous condition in most of the cases, PCNs represent a unique opportunity to prevent pancreatic cancer and to develop preemptive pancreatic surgery programs. However, the lack of predictive factors of the behaviour of these lesions, the low accuracy of AbstractPancreatic cystic neoplasms (PCNs) are a high prevalence disease. It is estimated that about 20% of the general population is affected by PCNs. Some of those lesions can progress till cancer, while others behave in a benign fashion. In particular intraductal papillary mucinous 29May 15, 2015|Volume 6|Issue 2|

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Intraductal papillary mucinous neoplasm

Cited by 112 publications

References 130 publications

Is It Time to Expand the Role of Total Pancreatectomy for IPMN?

Is It Time to Expand the Role of Total Pancreatectomy for IPMN?

Difficult Diagnostic Problems in Pancreatobiliary Neoplasia

Cystic tumors of the pancreas: Opportunities and risks

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