Mode of progression of intraductal papillary-mucinous tumor of the pancreas: analysis of patients with follow-up by EUS
- 2 August 2005
- journal article
- research article
- Published by Springer Science and Business Media LLC in The Esophagus
- Vol. 40 (7), 744-751
- https://doi.org/10.1007/s00535-005-1619-7
Abstract
We investigated the mode of progression of intraductal papillary-mucinous neoplasm of the pancreas (IPMN) in patients who underwent follow-up in order to elucidate the characteristics of malignancy and to establish an effective treatment strategy. Fifty-one patients with IPMN (branch-duct type, 47; main-duct type, 4) who had undergone follow-up study by endoscopic ultrasonography (EUS) were included (mean follow-up duration, 41.0+/-32.3 months; average number of EUS examinations performed during follow-up, 4.4). Chronological changes in EUS findings and histological findings of resected specimens were evaluated. Of the patients with the branch-duct type, only 2% showed enlargement of the dilated branches. In the main-duct-type group, an increase in size of the main pancreatic duct (MPD) was observed in 75% of the patients. In 14 patients with papillary protrusions, an increase in size and lateral spread was observed in 71% and 43%, respectively. No patients developed invasive cancer. In 15 patients who had thick septum-like structures (TSS), the development of papillary protrusions and that of invasive cancer were observed in 53% and 13%, respectively. Twenty-nine patients who had thin septum-like structures showed no change. Two patients with dense multilocular large cysts and TSS developed invasive cancer without change in the cystic lesions. One patient developed carcinoma with multifocal stromal invasion. Patients with branch-duct type IPMNs without papillary protrusions or TSS are not immediate candidates for surgery. Those who have small papillary protrusions have a benign course. It is recommended that patients with the large branch-duct type with TSS should undergo surgery. Attention should be paid to the entire pancreas when performing follow-up examinations in patients with branch-duct type IPMN, as invasive ductal adenocarcinoma can develop at a site in the pancreas different from that of the IPMN.Keywords
This publication has 20 references indexed in Scilit:
- Cystic Neoplasm of the PancreasPancreas, 2004
- Clonality and field cancerization in intraductal papillary-mucinous tumors of the pancreasCancer, 2001
- Evaluation of various imaging methods in the differential diagnosis of intraductal papillary-mucinous tumor (IPMT) of the pancreas.2001
- Intraductal Papillary Mucinous Tumors of the Pancreas Comprise 2 Clinical SubtypesArchives of Surgery, 1999
- Mucin-producing tumor of the pancreas--intraluminal ultrasonography.1999
- Intraductal papillary tumors of the pancreas: evaluation with endoscopic ultrasonographyGastrointestinal Endoscopy, 1998
- Solitary cystic tumor of the pancreas: EUS-pathologic correlationGastrointestinal Endoscopy, 1997
- Mucin-hypersecreting tumors of the pancreas: Assessing the grade of malignancy preoperativelyThe American Journal of Surgery, 1996
- [Clinicopathological and diagnostic study of mucin producing pancreatic tumors].1994
- c‐Ki‐rasPoint Mutations in Ductectatic‐type Mucinous Cystic Neoplasms of the PancreasJapanese Journal of Cancer Research, 1991