Surgical treatment of intraductal papillary-mucinous tumor (IPMT) of the pancreas: operative indications based on surgico-pathologic study focusing on invasive carcinoma derived from IPMT

Seki, Makoto; Yanagisawa, Akio; Ohta, Hiroyuki; Ninomiya, Yasuo; Sakamoto, Yoshihiro; Yamamoto, Junji; Yamaguchi, Toshiharu; Ninomiya, Eiji; Takano, Koichi; Aruga, Akiko; Yamada, Keiko; Sasaki, Keiko; Kato, Yukio

doi:10.1007/s00534-002-0746-2

Cited by 22 publications

(17 citation statements)

References 8 publications

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“…45,46 However, malignant IPMN was reported to acquire aggressive behavior similar to usual pancreatic carcinoma once it has invaded the pancreatic parenchyma. 47 Adequate pancreatic resection should be performed with D1 plus alpha or preferably D2 lymph node dissection in such patients. Accurate preoperative or intraoperative determination of the degree of parenchymal invasion can be obtained by EUS, dynamic CT, and intraoperative US.…”

Section: Treatmentmentioning

confidence: 99%

Clinical aspects of intraductal papillary mucinous neoplasm of the pancreas

et al. 2005

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Intraductal papillary mucinous neoplasm (IPMN) is a spectrum of neoplasia in the pancreatic duct epithelium characterized by cystic dilation of the main and/or branch pancreatic duct. According to the site of involvement IPMNs are classified into three categories, i.e., main duct type, branch duct type, and combined type. Most branch duct IPMNs are benign, whereas the other two types are often malignant. A large size of branch duct IPMN and marked dilation of the main pancreatic duct indicate the presence of adenoma at least. The additional existence of large mural nodules increases the possibility of malignancy in all types. Of recent interest is the relatively high prevalence of synchronous and/or metachronous malignancy in various organs, including the pancreas. The prognosis is favorable after complete resection of benign and noninvasive malignant IPMNs. Malignant IPMNs acquiring aggressiveness after parenchymal invasion necessitate adequate lymph node dissection. On the other hand, asymptomatic branch duct IPMNs without mural nodules can be observed without resection for a considerably long time. This review addresses available data, current understanding, controversy, and future directions.

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Section: Treatmentmentioning

confidence: 99%

Clinical aspects of intraductal papillary mucinous neoplasm of the pancreas

et al. 2005

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“…The lesion of the pancreas was diagnosed as an intraductal papillary mucinous tumor of the branch type, 30 mm in diameter. Because intraductal papillary mucinous tumor of the branch type is associated with relatively nonaggressive histologic features and low malignant potential, he received no treatment, but he was closely followed up 3. Two years later, although his serum CA 19‐9 level was 271 IU/ml, the size of the tumor had gradually increased, to 44 mm in diameter.…”

Section: Case Reportmentioning

confidence: 99%

Lymphoepithelial cyst of the pancreas associated with elevated CA 19-9 levels

Yamaguchi

Kagawa

Takeda

et al. 2008

J Hepatobiliary Pancreat Surg

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An extremely rare case of a lymphoepithelial cyst associated with persistent elevation of serum carbohydrate antigen (CA) 19-9 levels is described. A 72-year-old man was incidentally found to have a cystic tumor in the uncus of the pancreas and to have a high serum CA 19-9 level. At 2-year follow up, the tumor size had gradually increased and the high CA 19-9 level persisted. Because the malignant potential of the tumor could not be ruled out, a laparotomy was performed. The tumor was excised from the pancreas. On pathological examination, the tumor was proven to be a lymphoepithelial cyst. After the operation, the patient's serum CA 19-9 level decreased to the normal range. Lymphoepithelial cysts of the pancreas are a rare, benign entity. They are true pancreatic cysts, characterized by a mature, keratinizing, squamous lining surrounded by lymphoid tissue. Because the treatment options and the prognosis of these entities are quite different from those of other cystic neoplasms of the pancreas, preoperative differential diagnosis is the main issue. Thus, although they are rare, lymphoepithelial cysts should be considered in the differential diagnosis of cystic tumors of the pancreas.

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“…IPMT of the pancreas has been defined as a distinct pathological entity, characterized by intraductal papillary growth and thick mucin secretion 7. Intraductal tumors, even when malignant, are mostly resectable and have a relatively favorable prognosis, compared with that of pancreatic ductal adenocarcinoma 3. In terms of the unique pathological characteristics of IPMT, the appropriate surgical resection for IPMT has been debated for years 3.…”

Section: Discussionmentioning

confidence: 99%

“…Intraductal papillary‐mucinous tumor (IPMT) is a disease entity that has been defined recently by the WHO 2. There has been a discussion as to whether IPMT is benign or malignant in nature; therefore, definite standards and/or guidelines for an appropriate surgical procedure have not been established and have been debated for years 3. We experienced a case of IPMT occurring in the dorsal pancreatic duct, with the complete absence of the ventral pancreatic duct of Wirsung.…”

Section: Introductionmentioning

confidence: 99%

Intraductal papillary-mucinous tumor of the pancreas head with complete absence of the ventral pancreatic duct of Wirsung

Sakurai

Matsubara

Imazu

et al. 2004

J Hepatobiliary Pancreat Surg

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A case of intraductal papillary mucinous tumor of the pancreas with complete absence of the ventral pancreatic duct of Wirsung is presented. A 74-year-old Japanese man was admitted to our hospital because of elevated serum amylase concentration. Abdominal computed tomography (CT) scanning revealed diffuse dilatation of the main pancreatic duct and a diffuse and uncircumscribed area with heterogeneous density in the pancreas head. Endoscopic retrograde cholangiopancreatography revealed that the main pancreatic duct was connected with an accessory papilla and was diffusely dilated, without any irregularity of the duct wall being observed in the entire length of the duct. The common bile duct was detected only by cannulation through Vater's papilla, and no pancreatic duct or its communicating branch was found. Some branches, directed to the dorsal portion of the pancreas head, were found arising from the accessory pancreatic duct. Intraductal ultrasound examination performed through the accessory papilla and the common bile duct revealed a small tumor with a heterogeneous echo level in the pancreas head. From these findings, intraductal papillary-mucinous tumor (IPMT) occurring in the pancreas head was diagnosed, and pylorus-preserving pancreaticoduodenectomy was performed. The resected specimen revealed IPMT in the pancreas head. A roentgenographic study of the resected specimen revealed a defect caused by the tumor located in the pancreatic duct connected with the accessory papilla and showed that there was complete absence of the pancreatic duct connected with Vater's papilla. Surgical resection enabled us to completely analyze the duct system of pancreas divisum. Although it is not known whether there is a relationship between the pathogenesis of IPMT and embryological anomaly of the pancreatic duct system, this case may provide an insight into the pathogenesis of IPMT.

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Surgical treatment of intraductal papillary-mucinous tumor (IPMT) of the pancreas: operative indications based on surgico-pathologic study focusing on invasive carcinoma derived from IPMT

Cited by 22 publications

References 8 publications

Clinical aspects of intraductal papillary mucinous neoplasm of the pancreas

Clinical aspects of intraductal papillary mucinous neoplasm of the pancreas

Lymphoepithelial cyst of the pancreas associated with elevated CA 19-9 levels

Intraductal papillary-mucinous tumor of the pancreas head with complete absence of the ventral pancreatic duct of Wirsung

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