Intraductal papillary mucinous neoplasms and mucinous cystadenomas: current status and recommendations

Abstract

The real prevalence of pancreatic cystic lesions remains unknown. The malignant potential of some of these lesions remains a cause for significant concern. Thus, it is mandatory to develop a strategy to clearly discriminate those cysts with a potential for malignant transformation from those that do not carry any significant risk. Intraductal papillary mucinous neoplasms and mucinous cystadenomas are mucinous cystic neoplasms with a known malignant potential that have gained greater recognition in recent years. However, despite the numerous studies that have been carried out, their differential diagnosis among other cysts subtypes and their therapeutic approach continue to be a challenge for clinicians. This review contains a critical approach of the current recommendations and management strategies regarding intraductal papillary mucinous neoplasms and mucinous cystadenomas, as well as highlighting the limitations exposed in current guidelines.

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas: clinicopathological features and long-term outcomes following a pancreatectomy

“…Since the first description of IPMN by Ohashik in 1982 (7), this entity has been the subject of successive anatomical and clinical classifications with the aim of establishing prognostic criteria and treatment guidelines (1)(2)(3)(4)(5)(6)8,28,29). Apart from the heterogeneous anatomical and clinical presentation, another important aspect of the disease is the fact that it is a potentially invasive lesion and a precursor of ductal carcinoma of the pancreas.…”

“…Intraductal papillary mucinous neoplasm (IPMN) encompasses a wide spectrum of proliferative mucus-producing lesions with or without the formation of papillary growth. The entity may adopt three morphologic types depending on the anatomical type: main duct, branch type or mixed (1)(2)(3)(4)(5)(6). The most important issue is that these are potential precursor lesions for ductal carcinoma or papillary tubular carcinoma.…”

“…Since their first description by Ohashi et al (7) in 1982, these tumors have been classified in different ways in consensus documents and clinical guidelines in an attempt to establish a uniform taxonomy and appropriate therapeutic recommendations (1)(2)(3)(4)(5)(6)(7)(8)(9). In spite of their indolent clinical presentation (weight loss and abdominal pain), the increased use of more sensitive imaging techniques (computed tomography [CT] scans, high quality magnetic resonance imaging [MRIs], endoscopic ultrasound [EUS]) has led to an increase in their presentation as incidental lesions in the last decade.…”

Diagnostik und Therapie von zystischen Pankreastumoren

“…Allerdings verhalten sich die malignen MD-IPMN vom Intestinaltyp wie Kolloidkarzinome und haben eine bessere Prognose als die tubulären Karzinome, welche auf dem Boden des gastralen Typs eines BD-IPMN entstehen. Die malignen invasiven gastralen BD-IPMN haben eine genauso schlechte Prognose wie das duktale Adenokarzinom (PDAC) [6][7][8][9][10].…”

“…Diese Malignitätsrate ist niedriger als bei MD-IPMN, sodass man davon ausgehen muss, dass MCN einer langsameren malignen Transformation unterliegen. Während Patienten mit resezierten gutartigen MCN kurativ behandelt sind und eine exzellente Prognose haben, liegt die 5-JÜR auch bei den malignen invasiven MCN um die 60-80 %[6,27].…”