Should we regard all main duct type intraductal papillary mucinous neoplasms of the pancreas (MD-IPMN) as an indication of surgery? -A retrospective study in 29 patients with MD-IPMN showing mural nodules-

Masaki, Yoshiharu; Koshita, Shinsuke; Noda, Yutaka; Kanno, Yoshihide; Ogawa, Takahisa; Masu, Kaori; Sawai, Takashi; Ito, Kei

doi:10.1016/j.pan.2019.01.005

Cited by 12 publications

(9 citation statements)

References 15 publications

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“…Characteristics of articles included for qualitative and quantitative analysis are listed in Table 1 and Table 2 . From the 20 included articles [ 12 , 14 , 15 , 17 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 44 , 45 ], a total of 3982 resected IPMN cases (including BD-IPMN, MD-IPMN, or mixed-type IPMN) were collected. Of the 3982 resected cases, 1516 and 2466 were malignant and non-malignant cases, respectively.…”

Section: Resultsmentioning

confidence: 99%

Ductal Dilatation of ≥5 mm in Intraductal Papillary Mucinous Neoplasm Should Trigger the Consideration for Pancreatectomy: A Meta-Analysis and Systematic Review of Resected Cases

Oba

Beaty

et al. 2021

Cancers

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Intraductal papillary mucinous neoplasms (IPMN) are common but difficult to manage since accurate tools for diagnosing malignancy are unavailable. This study tests the diagnostic value of the main pancreatic duct (MPD) diameter for detecting IPMN malignancy using a meta-analysis of published data of resected IPMNs. Collected from a comprehensive literature search, the articles included in this analysis must report malignancy cases (high-grade dysplasia (HGD) and invasive carcinoma (IC)) and MPD diameter so that two MPD cut-offs could be created. The sensitivity, specificity, and odds ratios of the two cutoffs for predicting malignancy were calculated. A review of 1493 articles yielded 20 retrospective studies with 3982 resected cases. A cutoff of ≥5 mm is more sensitive than the ≥10 mm cutoff and has pooled sensitivity of 72.20% and 75.60% for classification of HGD and IC, respectively. Both MPD cutoffs of ≥5 mm and ≥10 mm were associated with malignancy (OR = 4.36 (95% CI: 2.82, 6.75) vs. OR = 3.18 (95% CI: 2.25, 4.49), respectively). The odds of HGD and IC for patients with MPD ≥5 mm were 5.66 (95% CI: 3.02, 10.62) and 7.40 (95% CI: 4.95, 11.06), respectively. OR of HGD and IC for MPD ≥10 mm cutoff were 4.36 (95% CI: 3.20, 5.93) and 4.75 (95% CI: 2.39, 9.45), respectively. IPMN with MPD of >5 mm could very likely be malignant. In selected IPMN patients, pancreatectomy should be considered when MPD is >5 mm.

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Section: Resultsmentioning

confidence: 99%

Ductal Dilatation of ≥5 mm in Intraductal Papillary Mucinous Neoplasm Should Trigger the Consideration for Pancreatectomy: A Meta-Analysis and Systematic Review of Resected Cases

Oba

Beaty

et al. 2021

Cancers

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“…In such cases, endoscopic approaches to obtain histocytological specimens for IPMNs may be effective for determining treatment plans for pancreatic diseases [ 13 – 17 ]. Although surgery is generally indicated when an MD-IPMN lesion has mural nodules on the basis of imaging findings, endoscopic approaches to obtain histocytological specimens may be necessary for some patients having MDIPMNs with mural nodules, like elderly patients and patients with several comorbidities, because approximately 40% of MD-IPMNs with mural nodules have been shown to be benign [ 15 ]; therefore, an MD-IPMN lesion with mural nodules may not be a prognostic factor for some patients with a high risk for surgery [ 18 ]. For this case, since total pancreatectomy, which was indicated for the patient on the basis of imaging findings, is a highly-invasive surgical procedure, endoscopic tissue acquisitions were performed at the 2 pancreatic lesions separately to determine whether or not total pancreatectomy should be performed.…”

Section: Discussionmentioning

confidence: 99%

Pancreatic Ductal Adenocarcinoma Concomitant with Main Duct Type Intraductal Papillary Mucinous Neoplasm of the Pancreas: A Case Report

et al. 2021

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Patient: Male, 67-year-old Final Diagnosis: Pancreatic ductal adenocarcinoma concomitant with main duct type intraductal papillary mucinous neoplasm of the pancreas Symptoms: Asymptomatic Medication:— Clinical Procedure: — Specialty: Gastroenterology and Hepatology Objective: Rare coexistence of disease or pathology Background: Intraductal papillary mucinous neoplasm of the pancreas (IPMN) and pancreatic ductal adenocarcinoma (PDAC) often coexist in the same pancreas. Almost all IPMNs involving PDACs concomitant with IPMN have been shown to be branch duct type IPMNs (BD-IPMNs), and their histological subtypes are gastric type. Therefore, PDACs concomitant with main duct type IPMNs (MD-IPMNs) are considered to be rare. We herein report a rare case preoperatively diagnosed as being a PDAC concomitant with MD-IPMN on the basis of imaging findings and histological findings of pancreatic specimens endoscopically obtained from 2 lesions. Case Report: A 67-year-old man was referred to our hospital due to an enlarged pancreas. Using imaging studies, a solid mass was found in the pancreatic head and intraductal papillary masses in the dilated main pancreatic duct of the body and tail with a fistula in the duodenum. On the basis of histological results using specimens endoscopically obtained from each of the 2 lesions, total pancreatectomy was planned due to suspected PDAC concomitant with an MD-IPMN. Finally, resected specimens were used to confirm the presence of a rare case of PDAC concomitant with MD-IPMN. Conclusions: We encountered a rare case of a PDAC concomitant with an MD-IPMN which could be preoperatively diagnosed by using imaging studies and histological specimens endoscopically obtained. In addition to invasive cancers derived from IPMNs, PDACs concomitant with IPMNs can rarely develop in the pancreas involving MD-IPMNs.

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“…Treatment plans vary according to the subtypes of IPMN. Surgical resection is recommended for MD-IPMN, especially those with main duct sizes >12 mm due to the high risk of malignant transformation [13]. However, treatment plans for BD-IPMN patients can vary according to risk stratifications in the international consensus guidelines [12].…”

Section: Discussionmentioning

confidence: 99%

Intraductal Papillary Mucinous Neoplasm of the Pancreas with Worrisome Features in a 12-Year-Old Boy

2020

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Should we regard all main duct type intraductal papillary mucinous neoplasms of the pancreas (MD-IPMN) as an indication of surgery? -A retrospective study in 29 patients with MD-IPMN showing mural nodules-

Cited by 12 publications

References 15 publications

Ductal Dilatation of ≥5 mm in Intraductal Papillary Mucinous Neoplasm Should Trigger the Consideration for Pancreatectomy: A Meta-Analysis and Systematic Review of Resected Cases

Ductal Dilatation of ≥5 mm in Intraductal Papillary Mucinous Neoplasm Should Trigger the Consideration for Pancreatectomy: A Meta-Analysis and Systematic Review of Resected Cases

Pancreatic Ductal Adenocarcinoma Concomitant with Main Duct Type Intraductal Papillary Mucinous Neoplasm of the Pancreas: A Case Report

Intraductal Papillary Mucinous Neoplasm of the Pancreas with Worrisome Features in a 12-Year-Old Boy

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