OC.09.5 SIZE AND SITE OF MAIN PANCREATIC DUCT DILATION CORRELATES WITH DISTINCT RISK OF MALIGNANCY IN MAIN-DUCT/ MIXED INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS OF THE PANCREAS

2020 ◽  
Vol 52 ◽  
pp. S30-S31
Author(s):  
S. Crippa ◽  
F. Aleotti ◽  
G. Belfiori ◽  
E. Longo ◽  
F. Di Salvo ◽  
...  
Surgery ◽  
2014 ◽  
Vol 156 (3) ◽  
pp. 611-621 ◽  
Author(s):  
Klaus Sahora ◽  
Carlos Fernández-del Castillo ◽  
Fei Dong ◽  
Giovanni Marchegiani ◽  
Sarah P. Thayer ◽  
...  

JAMA Surgery ◽  
2017 ◽  
Vol 152 (1) ◽  
pp. e163349 ◽  
Author(s):  
Motokazu Sugimoto ◽  
Irmina A. Elliott ◽  
Andrew H. Nguyen ◽  
Stephen Kim ◽  
V. Raman Muthusamy ◽  
...  

Pancreas ◽  
2019 ◽  
Vol 48 (6) ◽  
pp. 792-794
Author(s):  
Samuel Han ◽  
Isaac Raijman ◽  
Jorge D. Machicado ◽  
Steven A. Edmundowicz ◽  
Raj J. Shah

Author(s):  
F. Gallucci ◽  
D. Avolio ◽  
R. De Ritis ◽  
L. Ferrara ◽  
U. Valentino ◽  
...  

Intraductal papillary mucinous neoplasms (IPMNs) are rare pancreatic tumors, accounting for less than 1-2% of all neoplasms of the pancreas. The main characteristic of IPMNs is their favorable prognosis, as these pre-malignant or malignant lesions are usually slow-growing tumors and radical surgery is frequently possible. According to the localization of the lesions, three different tumor types have been identified: the main-duct IPMN, the branch-duct IPMN and the mixed-type IPMN (involving both the main pancreatic duct and the side branches). IMPNs do not present pathognomonic signs or symptoms. The obstruction of the main pancreatic duct system may cause abdominal pain and acute pancreatitis (single or recurrent episodes). The tumor may be incidentally discovered in asymptomatic patients, particularly in those with branch-duct IPMNs. In clinical practice, any non-inflammatory cystic lesion of the pancreas should be considered as possible IPMN. Computed tomography, magnetic resonance imaging with cholangiopancreatography and endoscopic ultrasonography can localize an IPMN and assess its morphology and size. The choice between non-operative and surgical management depends on the risk of malignancy and on the definitive distinction between benign and malignant IPMNs. Main-duct IPMNs have a high risk of malignant degeneration, especially in older patients. The clinical and radiological features, as well as treatment and outcome, of eight patients with IPMN (five with main-duct, two with branch-duct and one with mixed-type) observed by the authors over the last ten years are presented.


2019 ◽  
Vol 92 (1103) ◽  
pp. 20190461
Author(s):  
Ting Ting Zhang ◽  
Timothy J Sadler ◽  
Siobhan Whitley ◽  
Rebecca Brais ◽  
Edmund Godfrey

Objective: Main duct and mixed intraductal papillary mucinous neoplasms (IPMN) are pre-malignant cystic pancreatic neoplasms associated with pancreatic duct dilatation. Distinguishing these from benign causes of pancreatic duct dilatation is important in order to allow appropriate surveillance or surgery. A patulous duodenal papilla with extrusion of mucus at endoscopic evaluation, the endoscopic fish mouth ampulla (E-FMA) sign, is reported in main duct and mixed IPMN. We aimed to establish whether a CT correlate (CT-FMA) of this sign exists and whether this was associated with the presence of invasion or high-grade dysplasia. We defined the CT-FMA sign as an uninterrupted column of water attenuation material running from the pancreatic duct to the duodenal lumen. Methods: A retrospective, blinded review of 44 patients with histologically confirmed IPMN and 87 age-matched controls with pancreatic duct dilatation on CT was undertaken. A case–control series matched for the degree of pancreatic duct dilatation was used to compare the rates of invasion or high-grade dysplasia between main duct and mixed IPMN patients, with and without a CT-FMA sign. Results: The CT-FMA sign could be identified in 18.5% patients with main duct/mixed IPMN with specificity 100%, positive predictive value 100% and negative predictive value 79.8%. A significant association was found between CT-FMA in main duct/mixed IPMN compared to controls, but not with the presence of high-grade dysplasia or invasion. Conclusions: The CT-FMA sign is a newly reported, highly specific sign of MD and mixed IPMN. Advances in knowledge: If a fish mouth ampulla is identified at CT, a diagnosis of main duct or mixed IPMN is highly likely.


2015 ◽  
Vol 55 (4) ◽  
pp. 352-363 ◽  
Author(s):  
Julia Benzel ◽  
Volker Fendrich

Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are noninvasive neoplasms which occur in the main pancreatic duct or its major branches. IPMNs have an important meaning in the clinic and in research since they represent around 20% of all resected pancreatic neoplasms. Morphologically, branch duct, main duct and mixed-type IPMNs can be distinguished. Histologically, they can be divided into gastric, intestinal, pancreatobiliary and oncocytic type. There are different mutations in genes such as KRAS, GNAS, RNF43 and p53. The expression of miRNAs is specific to IPMNs; altogether, 14 miRNAs have been identified so far which are differently expressed in all IPMNs in contrast to normal pancreatic tissue. It has also been observed that methylation levels can be altered in IPMNs. This review summarizes the molecular characteristics of IPMNs of the pancreas and presents currently known markers.


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