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intraductal papillary mucinous neoplasm in chronic calcifying pancreatitis:Egg or hen?

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World Journal of Gastroenterology 2009年第10期15卷 1273-1275页

作者： Evangelos Kalaitzakis Barbara Braden Palak Trivedi Yalda Sharifi Roger Chapman Department of Gastroenterology John Radcliffe HospitalOxford OX3 9DUUnited Kingdom Section of Gastroenterology and Hepatology Department of Internal MedicineSahlgrenska University Hospital41345 GothenburgSweden

intraductal papillary mucinous neoplasm(IPMN)is an increasingly reported *** pancreatic calcification is generally thought to be a sign of chronic pancreatitis,but it may occur simultaneously with IPMN leading to diagnostic *** report a case of a patient initially diagnosed with chronic calcifying pancreatitis who was later shown to have a malignant *** case illustrates potential pitfalls in the diagnosis of IPMN in the case of extensive pancreatic calcification as well as clues that may lead the clinician to suspecting the *** possible mechanisms of the relation between pancreatic calcification and IPMN are also reviewed.

关键词： intraductal papillary mucinous neoplasm Endoscopic ultrasound Calcifying pancreatitis Carcinoembryonic antigen Endoscopic retrogradecholangiopancreatography

Concomitant pancreatic adenocarcinoma in a patient with branch-duct intraductal papillary mucinous neoplasm

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World Journal of Gastroenterology 2014年第27期20卷 9200-9204页

作者： Joanna K Law Christopher L Wolfgang Matthew J Weiss Anne Marie Lennon Division of Gastroenterology Johns Hopkins Hospital

Branch duct intraductal papillary mucinous neoplasms(BD-IPMN) are pre-malignant pancreatic cystic lesions which carry a small risk of malignant transformation within the cyst. Guidelines exist with respect to surveillance of the cysts using computed tomography, magnetic resonance imaging, and/or endoscopic ultrasound(EUS). There are reports that patients with IPMNs are at increased risk of developing pancreatic adenocarcinoma, which arises in an area separate to the IPMNs. We present two cases of pancreatic adenocarcinoma arising within the parenchyma, distinct from the IPMN-associated cyst, identified with EUS. This case report highlights that patients with BD-IPMN are at increased risk for pancreatic adenocarcinoma separate from the cyst and also the importance for endosonographers to carefully survey the rest of the pancreatic parenchyma separate from the cyst in order to identify small pancreatic adenocarcinomas.

关键词： Pancreatic adenocarcinoma intraductal papillary mucinous neoplasm Endoscopic ultrasound Surveillance

Pathological features and diagnosis of intraductal papillary mucinous neoplasm of the pancreas

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World Journal of Gastrointestinal Oncology 2014年第9期6卷 311-324页

作者： Víctor M Castellano-Megías Carolina Ibarrola-de Andrés Guadalupe López-Alonso Francisco Colina-Ruizdelgado Department of Pathology Hospital Universitario de Fuenlabrada Department of Pathology Hospital Universitario "12 de Octubre"

intraductal papillary mucinous neoplasm(IPMN) of the pancreas is a noninvasive epithelial neoplasm of mucinproducing cells arising in the main duct(MD) and/or branch ducts(BD) of the *** ducts are dilated and filled with neoplastic papillae and mucus in variable *** lacks ovarian-type stroma,unlike mucinous cystic neoplasm,and is defined as a grossly visible entity(≥ 5 mm),unlike pancreatic intraepithelial *** the use of high-resolution imaging techniques,very small IPMNs are increasingly being *** IPMNs are solitary and located in the pancreatic head,although 20%-40% are *** classification in MD type,BD type and mixed or combined type reflects biological differences with important prognostic and preoperative clinical management *** on cytoarchitectural atypia,IPMN is classified into low-grade,intermediategrade and high-grade *** on histological features and mucin(MUC) immunophenotype,IPMNs are classified into gastric,intestinal,pancreatobiliary and oncocytic *** different phenotypes can be observed together,with the IPMN classified according to the predominant *** pathways have been suggested:gastric phenotype corresponds to less aggressive uncommitted cells(MUC1-,MUC2-,MUC5 AC +,MUC6 +) with the capacity to evolve to intestinal phenotype(intestinal pathway)(MUC1-,MUC2 +,MUC5 AC +,MUC6- or weak +) or pancreatobiliary /oncocytic phenotypes(pyloropancreatic pathway)(MUC1 +,MUC 2-,MUC5 AC +,MUC 6 +) becoming more *** of IPMN is excellent but critically worsens when invasive carcinoma arises(about 40% of IPMNs),except in some cases of minimal *** clinical challenge is to establish which IPMNs should be removed because of their higher risk of developing invasive *** resected,they must be extensively sampled or,much better,submitted in its entirety for microscopic study to completely rule out associated invasive carcinoma.

关键词： mucinous pancreatic cysts intraductal papillary mucinous neoplasm Main duct intraductal papillary mucinous neoplasm Branch duct intraductal papillary mucinous neoplasm Mucins

Experience of limited pancreatic head resection for management of branch duct intraductal papillary mucinous neoplasm in a single center

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World Journal of Gastroenterology 2009年第23期15卷 2904-2907页

作者： Kwang Yeol Paik Seong Ho Choi Department of Surgery Kepco Medical Foundation Hanil General Hospital #388-1 Ssangmoon-Dong Dobong-Gu Seoul 132-033 South Korea Department of Surgery Samsung Medical Center College of Medicine Sungkyunkwan University #50 Irwon-Dong Gangnam-Gu Seoul 135-710 South Korea

AIM: To share our surgical experience and the outcome of limited pancreatic head resection for the management of branch duct intraductal papillary mucinous neoplasm (IPMN). METHODS: Between May 2005 and February 2008, nine limited pancreatic head resections (LPHR) were performed for IPMN of the pancreatic head. We reviewed the nine patients, retrospectively. RESULTS: Tumor was located in the uncinate process of the pancreas in all nine patients. Three patients had stents inserted in the main pancreatic duct due to injury. The mean size of tumor was 28.4 mm. Postoperative complications were found in f ive patients: 3 pancreatic leakages, a pancreatitis, and a duodenal stricture. Pancreatic leakages were improved by external drainage. No perioperative mortality was observed and all patients are recorded alive during the mean follow-up period of 17.2 mo. CONCLUSION: In selected patients after careful evaluation, LPHR can be used for the treatment of branch duct type IPMN. In order to avoid pancreatic ductal injury, preand intra-operative defi nite localization and careful operative techniques are required.

关键词： Limited pancreatic head resection Branchduct type intraductal papillary mucinous neoplasm

Data analysis of 36 cases with intraductal papillary mucinous neoplasm of the pancreas for their clinicopathological features, diagnosis, and treatment

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Chinese Medical Journal 2014年第23期127卷 4087-4091页

作者： Yuan Chunhui Xiu Dianrong Tao Ming Ma Zhaolai Jiang Bin Li Zhifei Li Lei Wang Liang Wang Hangyan Zhang Tonglin Department of General Surgery Peking University Third Hospital Beiiing 100191 China

Background intraductal papillary mucinous neoplasm （IPMN） is a rare pancreatic cystic neoplasm,accounting for 1％ of all exocrine pancreatic *** study aimed to summarize the clinicopathological and biological behaviors,as well as the experience in diagnosis and treatment of *** Clinicopathological data were collected from 36 cases with IPMN who were treated in Department of General Surgery,Peking University Third Hospital from May 2001 to July *** The 36 cases of IPMN patients included 27 males and 9 females （M∶F=3∶1）.The age of patients ranged from 52 to 78 years,with an average of 67.3 *** tumor location,20 tumors were located in pancreatic head,3 in pancreatic neck,10 in pancreatic body and tail,and 3 in the whole *** the 36 cases underwent surgical treatment,with 13 cases of pancreaticoduodenectomy,3 cases of middle pancreatectomy,7 cases of tumor resection plus pancreaticojejunostomy,3 cases of distal pancreatectomy,7 cases of distal pancreatectomy plus spleen resection,and 3 cases of total *** the 36 patients,9 patients underwent the operations under *** 36 cases included main duct type （14 cases,38.9％）,branch duct type （10 cases,27.7％）,and mixed duct type （12 cases,33.3％）.Pathologically,of the 36 cases,there were 7 IPMN adenomas,11 borderline IPMNs,6 IPMN with carcinomas in situ,and 12 IPMNs with invasive *** the 36 cases were followed *** an average of 42 months follow-up period （26-129 months）,no recurrence *** IPMN,which primarily occurs in male,is a low-grade malignancy which may involve any part of the pancreas,with specific clinicopathological *** is a different malignancy type from pancreatic ductal *** and laboratory examination are helpful for the diagnosis and differential *** prediction of invasive IPMN is still *** resection is recommended as the first choice of ***

关键词： pancreatic neoplasms diagnosis treatment intraductal papillary mucinous neoplasm laparoscopy

Multifocal intraductal papillary mucinous neoplasm of the pancreas-A case report

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World Journal of Gastroenterology 2009年第5期15卷 628-632页

作者： Kun-Chun Chiang Jun Te Hsu Shyh Chuan Jwo Tsann-Long Hwang Yi-Yin Jan Chun-Nan Yeh Department of Surgery Chang Gung Memorial Hospital Chang Gung University 5 Fu-Hsing Street Kwei-Shan Taoyuan Taiwan 333 China

Cystic neoplasms of the pancreas are relatively rare, comprising 10 percent of pancreatic cysts and only 1 percent of pancreatic cancers. Cystic neoplasms include mucinous cystic neoplasms, serous cystadenomas, papillary cystic tumors, cystic islet cell tumors and intraductal papillary mucinous neoplasms of the pancreas (IPMNs). IPMN was first described in 1982. It has been most commonly described in 60 to 70 years old males, and represents a relatively ''new'' but increasingly recognized disease. The improvement and widespread use of modern imaging equipments and heightened awareness of physicians contribute to the increasing incidence of IPMN. The majority of IPMNs are located in the pancreatic head (75%) while the rest involves the body/tail regions. Multifocal IPMNs have been hypothesized, but the true presence of multifocality is unknown. Here we present a 72-yearold male diagnosed with IPMN (carcinoma in situ ) in the pancreatic head and a branch duct type IPMN (duct atypia) in the pancreatic body and tail. The patient underwent a Whipple intervention and a distal pancreatectomy. A three-year disease-free survival has been observed so far.

关键词： intraductal papillary mucinous neoplasm Pancreas Multifocal Pancreatectomy intraductalpapillary mucinous neoplasms

Ultrasonographic Characteristics of intraductal papillary mucinous neoplasm of the Pancreas

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Chinese Medical Sciences Journal 2010年第3期25卷 151-155页

作者： Ke Lu Qing Dai Zhong-hui Xu Yi-xiu Zhang Li Tan Yan Yuan Yu-xin Jiang Department of Ultrasound Peking Union Medical College Hospita Chinese Academy of Medical Sciences ＆ Peking Union Medical College Beijing 100730 China

Objective To analyze the clinical and ultrasonographic imaging features of intraductal papillary mutinous neoplasm （1PMN） of the pancreas. Methods Twelve patients with IPMN underwent surgery between May 2005 and December 2008, including 4 （33.3%） with adenoma and 8 （66.7%） with adenocarcinoma. IPMN was classified preoperatively into 3 types based on sonographic findings of different sites： main duct, branch duct, and combined type. All clinical presentations and ultrasonographic findings of those paticnts were reviewed and the correlation be- tween ultrasonographic hndings and histopathological results was analyzed. Results There were 9 men and 3 women with a mean age of 60.1±9.6 years （range, 32-73）. OF all the 12 patients with IPMN, 9 （75.0%） had experienced some symptoms of epigastric discomfort and/or pain as cell as backache; 7 cases were with medical history of acute pancreatitis, 5 cases with diabetes, 4 cases with elevated CA19-9, and 2 cases with steatorrhea. All lesions of IPMN have been revealed by transabdominal ul- trasonography. The mean diameters of the lesions were 1.4±0.8 cm （range, 0.5-2.0） and 6.3±6.0 cm （range, 2.0-20.0） in adenomas and adenocarcinomas, respectively. And the mean diameters of the main duct in adelnomas and adenocarcinomas were 1.0±0.8 cm and 1.6±1.0 cm, respectively. Among the 4 adnomas, 3 （75.0%） cases were classified as branch type based on sonographic findings, and 2 were demonstrated as mural nodules in which no color signals was detected. Among the 8 adenocarcinomas, 5 （62.5%） cases were classifled as main duct type, and 3 （37.5%） as combined type. In 7 of the 8 adcnocarcinomas, mural nodules were detected within the dilated ducts or cysts of the lesions in which color flow signals were detected. Conclusions Transabdominal ultrasonography can reveal the pancreatic cystic lesions of IPMN as well as dilated pancreatic： ducts. Some characteristics should be noticed as suggesting the possibility of malignancy： clinical sympt

关键词： intraductal papillary mucinous neoplasm pancreas ultrasonography

Favorable response after radiation therapy for intraductal papillary mucinous neoplasms manifesting as acute recurrent pancreatitis:A case report

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World Journal of Clinical Cases 2022年第30期10卷 11116-11121页

作者： Ayaka Harigai Kiyoshi Kume Noriyoshi Takahashi So Omata Rei Umezawa Keiichi Jingu Atsushi Masamune Department of Radiation Oncology Tohoku University Graduate School of MedicineSendai 980-8574Japan Division of Gastroenterology Tohoku University Graduate School of MedicineSendai 980-8574Japan

BACKGROUND There has been an increasing number of elderly patients with intraductal papillary mucinous neoplasm(IPMN),who are surgically intolerant and require less invasive treatment options,which are *** the present study,we report a case of IPMN presenting with acute recurrent pancreatitis(ARP),in which radiation therapy effectively prevented further attacks of ARP and reduced tumor *** SUMMARY An 83-year-old man was referred to our hospital with an asymptomatic incidental pancreatic *** ultrasound imaging and magnetic resonance cholangiopancreatography revealed a multiloculated tumor in the head of the pancreas,with dilated pancreatic ducts and mural *** patient was diagnosed with mixed-type IPMN,and five years later,he developed *** endoscopic pancreatic ductal balloon dilatations failed to prevent further ARP *** was considered clinically inappropriate because of his old age and *** was referred to our department for radiation therapy targeted at those lesions causing intraductal hypertension and radiation was administered at a dose of 50 *** magnetic resonance imaging scan taken ten weeks after treatment revealed a decrease in tumor size and improvement of pancreatic duct *** months later,he remains symptom-free from *** This case highlights the important role of radiation therapy in mitigating the signs and symptoms of ARP in patients with inoperable IPMN.

关键词： intraductal papillary mucinous neoplasm Acute recurrent pancreatitis Pancreas Radiation therapy Case report

Pancreatic intraductal papillary mucinous neoplasms:Current diagnosis and management

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World Journal of Gastrointestinal Oncology 2021年第12期13卷 1880-1895页

作者： Beata Jabłońska PawełSzmigiel Sławomir Mrowiec Department of Digestive Tract Surgery Medical University of SilesiaKatowice 40-752Poland

intraductal papillary mucinous neoplasms(IPMNs)represent approximately 1%of all pancreatic neoplasms and 25%of cystic *** are divided into three types:main duct-IPMN(MD-IPPMN),branch duct-IPMN(BD-IPMN),and mixed *** this review,diagnostics,including clinical presentation and radiological investigations,were *** resonance imaging is the most useful for most *** depends on the type and radiological features of *** is recommended for *** BD-IPMN,management involves surgery or surveillance depending on the tumor size,cyst growth rate,solid components,main duct dilatation,high-grade dysplasia in cytology,the presence of symptoms(jaundice,new-onset diabetes,pancreatitis),and CA 19.9 serum *** patient’s age and comorbidities should also be taken into ***,there are different guidelines regarding the diagnosis and management of *** this review,the following guidelines were presented:Sendai International Association of Pancreatology guidelines(2006),American Gastroenterological Association guidelines,revised international consensus Fukuoka guidelines(2012),revised international consensus Fukuoka guidelines(2017),and European evidence-based guidelines according to the European Study Group on Cystic Tumours of the Pancreas(2018).The Verona Evidence-Based Meeting 2020 was also presented and discussed.

关键词： Pancreatic cyst Pancreatic cystic neoplasm intraductal papillary mucinous neoplasm Pancreatic cancer Pancreatectomy Guidelines