Intraductal papillary mucinous neoplasm of pancreas

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are neoplasms that are characterized by ductal dilation, intraductal papillary growth, and thick mucus secretion. This relatively recently defined pathology is evolving in terms of its etiopathogenesis, clinical features, diagnosis, management, and treatment guidelines. A PubMed database search was performed. All the relevant abstracts in English language were reviewed and the articles in which cases of IPMN could be identified were further scrutinized. Information of IPMN was derived, and duplication of information in several articles and those with areas of persisting uncertainties were excluded. The recent consensus guidelines were examined. The reported incidence of malignancy varies from 57% to 92% in the main duct-IPMN (MD-IPMN) and from 6% to 46% in the branch duct-IPMN (BD-IPMN). The features of high-risk malignant lesions that raise concern include obstructive jaundice in a patient with a cystic lesion in the pancreatic head, the findings on radiological imaging of a mass lesion of >30 mm, enhanced solid component, and the main pancreatic duct (MPD) of size ≥10 mm; while duct size 5-9 mm and cyst size <3 mm are considered as "worrisome features." Magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS) are primary investigations in diagnosing and following up on these patients. The role of pancreatoscopy and the analysis of aspirated cystic fluid for cytology and DNA analysis is still to be established. In general, resection is recommended for most MD-IPMN, mixed variant, and symptomatic BD-IPMN. The 5-year survival of patients after surgical resection for noninvasive IPMN is reported to be at 77-100%, while for those with invasive carcinoma, it is significantly lower at 27-60%. The follow-up of these patients could vary from 6 months to 1 year and would depend on the risk stratification for invasive malignancy and the pathology of the resected specimen. The understanding of IPMN has evolved over the years. The recent guidelines have played a role in this regard.

Original languageEnglish
Pages (from-to)160-175
Number of pages16
JournalNorth American Journal of Medical Sciences
Volume7
Issue number5
DOIs
Publication statusPublished - May 1 2015

Fingerprint

Pancreatic Neoplasms
Neoplasms
Guidelines
Pathology
Obstructive Jaundice
Pancreatic Ducts
Mucus
PubMed
Uncertainty
Cell Biology
Cysts
Dilatation
Consensus
Language
Magnetic Resonance Imaging
Databases
Carcinoma
Survival
DNA
Incidence

Keywords

  • Carcinoma of pancreas
  • Cystic tumors of pancreas
  • Intraductal papillary mucinous neoplasm (IPMN)
  • Magnetic resonance cholangiopancreatography (MRCP)

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Intraductal papillary mucinous neoplasm of pancreas. / Machado, Norman Oneil; Al Qadhi, Hani; Al Wahibi, Khalifa.

In: North American Journal of Medical Sciences, Vol. 7, No. 5, 01.05.2015, p. 160-175.

Research output: Contribution to journalArticle

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abstract = "Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are neoplasms that are characterized by ductal dilation, intraductal papillary growth, and thick mucus secretion. This relatively recently defined pathology is evolving in terms of its etiopathogenesis, clinical features, diagnosis, management, and treatment guidelines. A PubMed database search was performed. All the relevant abstracts in English language were reviewed and the articles in which cases of IPMN could be identified were further scrutinized. Information of IPMN was derived, and duplication of information in several articles and those with areas of persisting uncertainties were excluded. The recent consensus guidelines were examined. The reported incidence of malignancy varies from 57{\%} to 92{\%} in the main duct-IPMN (MD-IPMN) and from 6{\%} to 46{\%} in the branch duct-IPMN (BD-IPMN). The features of high-risk malignant lesions that raise concern include obstructive jaundice in a patient with a cystic lesion in the pancreatic head, the findings on radiological imaging of a mass lesion of >30 mm, enhanced solid component, and the main pancreatic duct (MPD) of size ≥10 mm; while duct size 5-9 mm and cyst size <3 mm are considered as {"}worrisome features.{"} Magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS) are primary investigations in diagnosing and following up on these patients. The role of pancreatoscopy and the analysis of aspirated cystic fluid for cytology and DNA analysis is still to be established. In general, resection is recommended for most MD-IPMN, mixed variant, and symptomatic BD-IPMN. The 5-year survival of patients after surgical resection for noninvasive IPMN is reported to be at 77-100{\%}, while for those with invasive carcinoma, it is significantly lower at 27-60{\%}. The follow-up of these patients could vary from 6 months to 1 year and would depend on the risk stratification for invasive malignancy and the pathology of the resected specimen. The understanding of IPMN has evolved over the years. The recent guidelines have played a role in this regard.",
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