Tumor papilar, mucinoso e intraductal: abordaje diagnóstico y terapéutico

Rı́os, Susana; Noia, J. Lariño; García, J. Iglesias; León, Antonio Lozano; Muñoz, J.E. Domínguez

doi:10.1157/13116092

Cited by 2 publications

(4 citation statements)

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“…With occasion of a new classification of the exocrine pancreatic tumor, in 1996 World Health Organization (WHO), defined IPMN as the intraductal papillary growth of mucin-producing columnar epithelia (17). This classification and the revised WHO 2000's classification have disclosured previous misunderstanding and confusing terms (5,6).…”

Section: Discussionmentioning

confidence: 98%

“…Intraductal papillary mucinous neoplasm (IPMN) of the pancreas encompasses a spectrum of histological and clinical entities which have raised great attention in the last decade (1)(2)(3)(4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

“…The clinical series of IPMN was first described by Ohhashi in 1982 and Sessa introduced the term of IPMN in 1994 (7,8). The growing histopathological evidence showing that 20-30% of the IPMN cases are multifocal and that 5-10% of IPMN disease involve whole pancreatic gland has raised multiple controversies regarding the appropriate surgical treatment and interval follow-up of these patients (1)(2)(3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

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Intraductal papillary mucinous neoplasms (IPMN) of the pancreas: clinico-pathologic results

Cienfuegos

Rotellar

Cruchaga

et al. 2010

Rev. esp. enferm. dig.

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Background: intraductal papillary mucinous neoplasm (IPMN) shows a series of lesions which evolve from benign lesions -adenoma-to invasive carcinoma.Aim: to analyze the clinical and pathological results of 15 patients diagnosed of IPMN, and surgically treated according to the guidelines of International Consensus Conference.Material and methods: a retrospective analysis of 15 patients surgically treated between March 1993 and September 2009, according to the International Consensus recommendation. Demographic, diagnostic tools, surgical report, pathologic database and actuarial survival were analyzed with a follow-up from one and a half month through nine years.Results: 6 patients underwent pancreaticoduodenectomies, 4 total pancreatectomies, 2 body or central pancreatectomies, 2 partial pancreatectomies (enucleation) and 1 distal pancreatectomy. A morbidity of 46 and 0% hospital mortality were assessed, with a median length hospital stay of 10 days. In five cases, the IPMN was combined type (both main and branch pancreatic ducts involved) in four main duct-type and branch duct-type in the another six as well. Several atypia (IPMN carcinoma in situ) was observed in 2 patients and invasive carcinoma with negative lymph nodes was identified in 3 patients. A patient without invasive carcinoma died at 66 months of follow-up for pancreas adenocarcinoma. The actuarial survival up to recurrence or death was 105,133 months with a range of follow-up from 1 month and a half until 9 years.Conclusions: IPMN main duct or mixed type warrants complete resection due to its incidence of invasive carcinoma or precursor lesions of malignancy as well. Due to its multifocal pattern, patients should be followed in long-term surveillance. The management of asymptomatic IPMN type branch less than 3 cm is controversial. RESUMENIntroducción: la neoplasia papilar mucinosa intraductal (NPMI) del páncreas comprende una serie de lesiones que evolucionan desde lesiones benignas (adenoma) hasta carcinoma ductal invasivo.Objetivo: analizar los resultados clínicos y patológicos de 15 pacientes diagnosticados de NPMI e intervenidos según las recomendaciones de conferencia de consenso.Material y métodos: análisis retrospectivo de 15 pacientes con NPMI, intervenidos entre marzo de 1993 y septiembre de 2009; según pautas de conferencias de consenso internacionales. Se recogieron datos demográficos, pruebas diagnósticas, tipo de intervención, histopatología y supervivencia actuarial con un seguimiento entre mes y medio y nueve años.Resultados: se realizaron 6 duodenopancreatectomías cefálicas, 4 pancreatectomías totales, 2 pancreatectomías centrales, 2 pancreatectomías parciales y una pancreatectomía distal. Se registró una morbilidad del 40%, sin mortalidad operatoria, con una estancia media de 10 días. En 5 casos la NPMI fue de tipo mixto, en 4 afectaba al conducto pancreático y en los 6 restantes a ramas accesorias. Dos pacientes presentaron carcinoma in situ y 3 carcinoma invasivo con ganglios negativos. Un paciente, sin carcinoma invasivo, fallec...

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Intraductal papillary mucinous neoplasms (IPMN) of the pancreas: clinico-pathologic results

Cienfuegos

Rotellar

Cruchaga

et al. 2010

Rev. esp. enferm. dig.

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“…The role of the different imaging techniques in the evaluation of cystic pancreatic lesions also requires comment. EUS is more sensitive than both CT and MRI for the detection of small, predominantly cystic, pancreatic lesions, with good to excellent concordance between EUS and MRI regarding lesion number, size, and location [28]. A recent expert consensus agreed that initial screening should include EUS and/or MRI [25].…”

mentioning

confidence: 99%

Early detection of pancreatic cancer in patients with intraductal papillary mucinous neoplasms: the pivotal role of endoscopic ultrasound

Iglesias‐García

Domínguez-Muñoz

2013

Endoscopy

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Editorial 30Pancreatic cancer is the fifth leading cause of cancer death in Western countries, and the second highest cause of cancer death among gastrointestinal tumors, with more than 250 000 deaths per year worldwide. With a death rate that nearly equals its incidence, pancreatic cancer is considered to be one of the malignant tumors with the poorest survival [1,2]. The only group of patients with pancreatic cancer who have an acceptable prognosis are those with potentially resectable lesions [3 -6]. In this context, there is significant interest in the screening and early detection of pancreatic cancer. The knowledge that pancreatic cancer arises from morphologically well-defined, noninvasive precursor lesions, such as intraductal papillary mucinous neoplasms (IPMNs) and pancreatic intraepithelial neoplasia [7,8], can be crucial for detection of curable lesions since treating these precursor lesions may prevent the development of pancreatic cancer [9]. Regarding IPMNs, according to the international consensus guidelines of 2012 [10], surgical resection is indicated for main duct IPMNs. However the management of branch duct IPMNs is still controversial since they are associated with a lower risk of malignancy. Only lesions with high risk stigmata and/or worrisome features are considered to be appropriate for surgery. In this issue of Endoscopy, a study from Kamata et al. provides important information on this subject [11]. The authors followed up patients with branch duct IPMNs without signs of malignancy. During a 5-year follow-up, no mural nodules arose, the lesion increased in size in only 3 % of cases and these were finally diagnosed as IPMN adenomas; thus there were no cases of carcinomas derived from IPMNs in their series. These findings suggest that most branch duct IPMNs can be followed up. Another important issue is the presence of concomitant pancreatic cancer at the first examination for IPMNs. Kamata et al. identified 11 concomitant pancreatic adenocarcinomas (7 %), which underlines the importance of a careful evaluation of the pancreatic parenchyma at the time of diagnosis of IPMN. But the reported rate for pancreatic cancer found during follow-up of IPMNs, at around 4 % to 7 %, is also important [12 -14]. Notably, in the study from Kamata et al., the rate for concomitant pancreatic tumors found during follow-up rises to 8.8 %. Given this data, careful evaluation of the pancreatic parenchyma in all of our patients with IPMNs, both at the time of diagnosis and during follow-up, is clearly essential. In this setting, very sensitive imaging techniques should be used to allow detection of these solid tumors within the pancreas at early stages. Kamata et al. provide the first study reporting a long follow-up period (over 5 years) using endoscopic ultrasound (EUS) as the main imaging technique. This approach differs from other studies where computed tomography (CT) scan was the procedure of choice. In fact the authors considered that the use of EUS was crucial with regard to the increased detection rate...

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Tumor papilar, mucinoso e intraductal: abordaje diagnóstico y terapéutico

Cited by 2 publications

References 43 publications

Intraductal papillary mucinous neoplasms (IPMN) of the pancreas: clinico-pathologic results

Intraductal papillary mucinous neoplasms (IPMN) of the pancreas: clinico-pathologic results

Early detection of pancreatic cancer in patients with intraductal papillary mucinous neoplasms: the pivotal role of endoscopic ultrasound

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