Intraductal Papillary Mucinous Tumors of the Pancreas Comprise 2 Clinical Subtypes

Kobari, Masao; Egawa, Shinichi; Shibuya, Kazuhiko; Shimamura, Hiromune; Sunamura, Makoto; Takeda, Kazunori; Matsuno, Seiki; Furukawa, Toru

doi:10.1001/archsurg.134.10.1131

Cited by 315 publications

(205 citation statements)

References 18 publications

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“…Pathologically, IPMNs can manifest with different degrees of cellular atypia, ranging from hyperplasia, to adenoma with varying degrees of dysplasia or invasive carcinoma. IPMNs can be classified as either main duct IPMNs or branch duct IPMNs based on imaging studies [2,3]. Main pancreatic duct types are indicated for surgery regardless of the presence of intramural nodules; cyst diameter, main pancreatic duct diameter, and the presence of intramural nodules are considered important findings for branch duct types.…”

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confidence: 99%

Utility of Multidetector Row CT in Diagnosing Branch Duct IPMNs of the Pancreas Compared with MR Cholangiopancreatography and Endoscopic Ultrasonography

et al. 2010

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confidence: 99%

Utility of Multidetector Row CT in Diagnosing Branch Duct IPMNs of the Pancreas Compared with MR Cholangiopancreatography and Endoscopic Ultrasonography

et al. 2010

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“…Similar survival rates are seen in patients with mucinous cystic neoplasms [67]. Side branch lesions arising from IPMN have a better prognosis than main duct IPMN [68]. The worst prognosis is for advanced, transmural adenocarcinomas arising from mucinous lesions; the 5-year survival is only 30 % for resected lesions.…”

Section: Prognosismentioning

confidence: 64%

Cystic pancreatic lesions: Can we diagnose them accurately what to look for? FNA marker molecular analysis resection, surveillance, or endoscopic treatment?

Brugge

2006

Endoscopy

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IntroductionCystic lesions of the pancreas consist of a spectrum of benign, pre-malignant, and malignant malignancies. In the past, cystic neoplasms of the pancreas were thought to be relatively rare, but the widespread use of cross sectional imaging has dramatically increased ability to detect these lesions. Although the vast majority of pancreatic cysts are discovered incidentally, large or invasive lesions may produce sufficient symptoms to cause the patient to seek medical attention.Cystic neoplasms are often confused or misdiagnosed as pseudocysts or peripancreatic collections of inflammatory fluid that may morphologically mimic cystic neoplasms. Furthermore, the presenting symptoms of pseudocysts may be identical to the symptoms associated with cystic neoplasms.Cystic neoplasms of the pancreas are traditionally organized by the type of lining epithelium since this feature dominates the risk of malignancy and management [1] ( Table 1). There are three types of mucinous lesions, benign mucinous cystadenomas, malignant mucinous cystic lesions, and intra-ductal papillary mucinous neoplasms (IPMNs). The non-mucinous lesions include serous cystadenomas, cystic endocrine tumors and other rare lesions. PrevalenceThe prevalence of pancreatic cysts has been examined with autopsy examinations of the pancreas in adults without known pancreatic disease. The prevalence of pancreatic cysts found at autopsies in Japan was approximately 73 of 300 autopsies (24.3 %) cases [2]. The prevalence of cysts increased with increasing age of the patient. The cysts were located throughout the pancreatic parenchyma and were not related to chronic pancreatitis. The epithelium of the cysts displayed a spectrum of neoplastic change, including atypical hyperplasia (16.4 %); carcinoma in situ (3.4 %).

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“…38 In general, it is felt that the presence of carcinoma at the surgical margins bears too high a risk for the patient, and further therapy is probably warranted for these patients, if clinically feasible. On the other hand, the presence of 'adenomatous' epithelium at the pancreatic parenchymal margin is probably negligible 49,[62][63][64][65] (based on what we extrapolate from the branch-duct literature); however, the relative risk of later developing an invasive carcinoma in these patients is also rather difficult to determine.…”

Section: Intraductal Papillary Mucinous Neoplasmsmentioning

confidence: 91%

“…49,[62][63][64][65] Some authors believe this variant is a biologically distinct entity, and therefore every attempt should be made during macroscopic examination to determine the distribution of the lesion. 47,49,60,62,[64][65][66][67] IPMNs may be localized, multicentric or, rarely, the entire ductal system may be involved. Careful examination and sampling of the specimen for an invasive carcinoma component is of vital importance.…”

Section: Intraductal Papillary Mucinous Neoplasmsmentioning

confidence: 99%

Cystic lesions of the pancreas

Adsay

2007

Modern Pathology

191

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Although cystic tumors of the pancreas are relatively rare, they constitute an increasingly important category. Advances in imaging and interventional techniques and the sharp drop in the mortality rate of pancreatic surgery have rendered pancreatic biopsies and resections commonplace specimens. Consequently, in the past two decades, the nature of many cystic tumors in this organ has been better characterized. The names of some existing entities were revised; for example, what was known as papillary-cystic tumor is now regarded as solidpseudopapillary tumor. New entities, in particular, intraductal papillary mucinous neoplasm and its variants, such as oncocytic and intestinal subtypes were recognized. The importance of clinical and pathologic correlation in the evaluation of these lesions was appreciated, in particular, with regards to the multifocality of these lesions, their association with invasive carcinomas, and thus their 'preinvasive' nature. Consensus criteria for the distinction of these from the ordinary precursors of adenocarcinoma, the pancreatic intraepithelial neoplasia, were established. The definition of mucinous cystic neoplasms was refined; ovarian-like stroma has now become almost a requirement for the diagnosis of mucinous cystic neoplasia, and defined as such, the propensity of these tumors to occur in perimenopausal women became even more striking. The validity and clinical value of classifying the pancreatic cysts of mucinous type as adenoma, borderline, CIS and invasive have been established. Related to this, the importance of thorough sampling in accurate classification of these mucinous lesions was recognized. Greater accessibility of the pancreas afforded by improved invasive as well as noninvasive modalities has also increased the detection of otherwise clinically silent cystic tumors, which has led to the recognition of more innocuous entities such as acinar cell cystadenoma and squamoid cyst of pancreatic ducts. As the significance of the cystic lesions emerged, cystic forms of otherwise typically solid tumors were also better characterized. Thus, significant developments have taken place in the classification and our understanding of pancreatic cystic tumors in the past few years, and experience with these lesions is likely to grow exponentially in the coming years. Modern Pathology (2007) 20, S71-S93.

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Intraductal Papillary Mucinous Tumors of the Pancreas Comprise 2 Clinical Subtypes

Abstract: Intraductal papillary mucinous tumors (IPMTs) of the pancreas may be meaningfully construed as representing 2 clinically distinct subtypes: main duct tumors (MDT) and branch duct tumors (BDT).

Cited by 315 publications

References 18 publications

Utility of Multidetector Row CT in Diagnosing Branch Duct IPMNs of the Pancreas Compared with MR Cholangiopancreatography and Endoscopic Ultrasonography

Utility of Multidetector Row CT in Diagnosing Branch Duct IPMNs of the Pancreas Compared with MR Cholangiopancreatography and Endoscopic Ultrasonography

Cystic pancreatic lesions: Can we diagnose them accurately what to look for? FNA marker molecular analysis resection, surveillance, or endoscopic treatment?

Cystic lesions of the pancreas

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