Intraductal papillary mucinous neoplasms of the pancreas complicated with intraductal hemorrhage, perforation, and fistula formation: CT and MR imaging findings with pathologic correlation

Yamada, Yoshitake; Mori, Hiromu; Hijiya, Naoki; Matsumoto, Shunro; Takaji, Ryo; Ohta, Masayuki; Kitano, Seigo; Moriyama, Masatsugu

doi:10.1007/s00261-011-9723-z

Cited by 25 publications

(23 citation statements)

References 17 publications

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“…28 Other symptoms that include back pain, weight loss, NOD, and obstructive jaundice are more often associated with malignant transformation of an IPMN but, once again, are not entirely specific. [29][30][31][32]34,35,37,[46][47][48][49][50][51][52] Considering the lack of symptoms in most patients, conventional imaging modalities play a crucial role in the identification of IPMNs and IPMN-associated PDAC, as well as in the detection of a concomitant carcinoma. Here, we discuss the performance of imaging modalities used in the context of cystic lesions; later, we discuss choice of imaging in the context of solid lesions (noncystic PDAC).…”

Section: Diagnostic Methods Of Evaluating Bd-ipmn Patientsmentioning

confidence: 99%

Early Detection of Pancreatic Cancer: Opportunities and Challenges

et al. 2019

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Most patients with pancreatic ductal adenocarcinoma (PDAC) present with symptomatic, surgically unresectable disease. Although the goal of early detection of PDAC is laudable and likely to result in significant improvement in overall survival, the relatively low prevalence of PDAC renders general population screening infeasible. The challenges of early detection include identification of atrisk individuals in the general population who would benefit from longitudinal surveillance programs and appropriate biomarker and imaging-based modalities used for PDAC surveillance in such cohorts. In recent years, various subgroups at higher-than-average risk for PDAC have been identified, including those with familial risk due to germline mutations, a history of pancreatitis, patients with mucinous pancreatic cysts, and elderly patients with new-onset diabetes. The last 2 categories are discussed at length in terms of the opportunities and challenges they present for PDAC early detection. We also discuss current and emerging imaging modalities that are critical to identifying early, potentially curable PDAC in high-risk cohorts on surveillance.

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Section: Diagnostic Methods Of Evaluating Bd-ipmn Patientsmentioning

confidence: 99%

Early Detection of Pancreatic Cancer: Opportunities and Challenges

et al. 2019

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“…This explains, in advanced/bigger tumors, the presence of fistula with the common bile duct and extrapapillary duodenum with solid colonization, or the peritoneal diffusion as pseudomyxoma peritonei even if exceedingly rare [14,63].…”

Section: Uncommon Presentationsmentioning

confidence: 94%

Uncommon presentations of common pancreatic neoplasms: a pictorial essay

et al. 2015

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Pancreatic neoplasms are a wide group of solid and cystic lesions with different and often characteristic imaging features, clinical presentations, and management. Among solid tumors, ductal adenocarcinoma is the most common: it arises from exocrine pancreas, comprises about 90% of all pancreatic neoplasms, and generally has a bad prognosis; its therapeutic management must be multidisciplinary, involving surgeons, oncologists, gastroenterologists, radiologists, and radiotherapists. The second most common solid pancreatic neoplasms are neuroendocrine tumors: they can be divided into functioning or non-functioning and present different degrees of malignancy. Cystic pancreatic neoplasms comprise serous neoplasms, which are almost always benign, mucinous cystic neoplasms and intraductal papillary mucinous neoplasms, which can vary from benign to frankly malignant lesions, and solid pseudopapillary tumors. Other pancreatic neoplasms, such as lymphoma, metastases, or pancreatoblastoma, are rarely seen in clinical practice and have different and sometimes controversial managements. Rare clinical presentations and imaging appearance of the most common pancreatic neoplasms, both solid and cystic, are more frequently seen and clinically relevant than rare pancreatic tumors; their pathologic and radiologic appearances must be known to improve their management. The purpose of this paper is to present some rare or uncommon clinical and radiological presentations of common pancreatic neoplasms providing examples of multi-modality imaging approach with pathologic correlations, thus describing the histopathological bases that can explain the peculiar imaging features, in order to avoid relevant misdiagnosis and to improve lesion management.

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“…Rarely, atypical appearances of complicated IPMNs have been reported: intraductal hemorrhage, perforation, and fistula formation [68].…”

Section: Atypicalmentioning

confidence: 99%

“…Although the mechanism of intraductal hemorrhage is still unclear, it is believed that the exposure of the neoplastic epithelium to high pressure produced by mucin results in denudating the epithelium, with intraductal hemorrhage occurring due to injury to the small vessels around the epithelium [68].…”

Section: Atypicalmentioning

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 neoplasms of the pancreas complicated with intraductal hemorrhage, perforation, and fistula formation: CT and MR imaging findings with pathologic correlation

Abstract: Complications with IPMN could be recognized on CT and fat-suppressed T1-weighted MR images. Intraductal hemorrhage might be predictive sign of perforation and fistula formation.

Cited by 25 publications

References 17 publications

Early Detection of Pancreatic Cancer: Opportunities and Challenges

Early Detection of Pancreatic Cancer: Opportunities and Challenges

Uncommon presentations of common pancreatic neoplasms: a pictorial essay

Intraductal Papillary Mucinous Neoplasm (IPMN)

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