scholarly journals Branch Duct Intraductal Papillary Mucinous Neoplasms: Recommendations for Follow-Up and Surgery

2020 ◽  
Vol 109 (1) ◽  
pp. 34-41
Author(s):  
A. Caravati ◽  
S. Andrianello ◽  
T. Pollini ◽  
M. Biancotto ◽  
A. Balduzzi ◽  
...  
Keyword(s):  
High Volume ◽  
Cystic Neoplasm ◽  
Pancreatic Cysts ◽  
Intraductal Papillary Mucinous Neoplasms ◽  
Branch Duct ◽  
Cystic Neoplasms ◽  
Increased Risk ◽  
Mucinous Neoplasms ◽  
Risk Of Malignancy

Background and Aims: Pancreatic cysts are increasingly diagnosed, mainly during abdominal imaging performed for other reasons. Between pancreatic cystic neoplasm, intraductal papillary mucinous neoplasms are the most common pre-malignant entities. Intraductal papillary mucinous neoplasms involving side branches overall harbor a low risk of malignancy, and in the recent past, a progressively more conservative approach has been consolidated. Purpose of this report is to summarize the evidence supporting the current practice for the management of branch duct intraductal papillary mucinous neoplasm and to offer a useful practical guide from first observation to post-operative follow-up. Materials and Methods: Review of the most important scientific literature on intraductal papillary mucinous neoplasms was made. In this review article, we also report the experience of a high volume center in managing Pancreatic cystic neoplasms. Results: The correct management during surveillance still is a matter of debate, since many guidelines have been published suggesting different clinical approaches. Recently, follow-up discontinuation has also been proposed in selected cases. Conclusion: Despite significant improvements made by the increase of evidence, selecting surgical candidates because of an increased risk of malignant progression remains an unsolved issue and a hot topic for pancreatologists.

scholarly journals The Utilization of Imaging Features in the Management of Intraductal Papillary Mucinous Neoplasms

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Stefano Palmucci ◽  
Claudia Trombatore ◽  
Pietro Valerio Foti ◽  
Letizia Antonella Mauro ◽  
Pietro Milone ◽  
...  
Keyword(s):  
Pancreatic Cysts ◽  
Low Grade ◽  
Imaging Features ◽  
Main Duct ◽  
Intraductal Papillary Mucinous Neoplasms ◽  
Branch Duct ◽  
Cystic Neoplasms ◽  
Radiological Features ◽  
Increased Risk ◽  
Mucinous Neoplasms

Intraductal papillary mucinous neoplasms (IPMNs) represent a group of cystic pancreatic neoplasms with large range of clinical behaviours, ranging from low-grade dysplasia or borderline lesions to invasive carcinomas. They can be grouped into lesions originating from the main pancreatic duct, main duct IPMNs (MD-IPMNs), and lesions which arise from secondary branches of parenchyma, denominated branch-duct IPMNs (BD-IPMNs). Management of these cystic lesions is essentially based on clinical and radiological features. The latter have been very well described in the last fifteen years, with many studies published in literature showing the main radiological features of IPMNs. Currently, the goal of imaging modalities is to identify “high-risk stigmata” or “worrisome feature” in the evaluation of pancreatic cysts. Marked dilatation of the main duct (>1 cm), large size (3–5 cm), and intramural nodules have been associated with increased risk of degeneration. BD-IPMNs could be observed as microcystic or macrocystic in appearance, with or without communication with main duct. Their imaging features are frequently overlapped with cystic neoplasms. The risk of progression for secondary IPMNs is lower, and subsequently an imaging based follow-up is very often proposed for these lesions.

scholarly journals Branch Duct Intraductal Papillary Mucinous Neoplasms (BD-IPMN): Risk of Malignancy Still Present After 5 Years of Follow-up

2011 ◽  
Vol 140 (5) ◽  
pp. S-714-S-715
Author(s):  
Wafaa Khannoussi ◽  
Marie-Pierre Vullierme ◽  
Frédérique Maire ◽  
Vinciane Rebours ◽  
Alain Sauvanet ◽  
...  
Keyword(s):  
Intraductal Papillary Mucinous Neoplasms ◽  
Branch Duct ◽  
Mucinous Neoplasms ◽  
Risk Of Malignancy

scholarly journals Long-term Risk of Malignancy in Branch-Duct Intraductal Papillary Mucinous Neoplasms

2020 ◽  
Vol 158 (1) ◽  
pp. 226-237.e5 ◽  
Author(s):  
Hiroki Oyama ◽  
Minoru Tada ◽  
Kaoru Takagi ◽  
Keisuke Tateishi ◽  
Tsuyoshi Hamada ◽  
...  
Keyword(s):  
Intraductal Papillary Mucinous Neoplasms ◽  
Branch Duct ◽  
Mucinous Neoplasms ◽  
Risk Of Malignancy

Long-Term Clinical and Imaging Follow-Up of Nonoperated Branch Duct Form of Intraductal Papillary Mucinous Neoplasms of the Pancreas

Pancreas ◽  
2012 ◽  
Vol 41 (2) ◽  
pp. 295-301 ◽  
Author(s):  
Audrey Arlix ◽  
Barbara Bournet ◽  
Philippe Otal ◽  
Guillaume Canevet ◽  
Aldine Thevenot ◽  
...  
Keyword(s):  
Intraductal Papillary Mucinous Neoplasms ◽  
Branch Duct ◽  
Mucinous Neoplasms

Pancreatic cysts or pancreatic cystic neoplasms? An analysis of 145 cases.

2018 ◽  
Vol 90 (4) ◽  
pp. 1-4
Author(s):  
Aleksandra Oleśna ◽  
Michał Wlaźlak ◽  
Janusz Strzelczyk ◽  
Marian Danilewicz
Keyword(s):  
Cystic Lesion ◽  
Demographic Data ◽  
Pancreatic Cysts ◽  
Histopathological Diagnosis ◽  
Cystic Neoplasms ◽  
Pancreatic Cystic Lesion ◽  
Cystic Tumors ◽  
Mucinous Neoplasms ◽  
Risk Of Malignancy ◽  
History Of

Introduction Frequency of detection of pancreatic cystic lesions increased recent years. The majorities are pseudocysts, the remaining cysts are mainly neoplasms. Proven risk of malignancy affects intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms (MCN). Material and methods 145 patients operated on at the Department of General and Transplant Surgery in Barlicki Hospital in Lodz, Poland, in 2007-2016 due to pancreatic cystic lesion. The type of surgery, histopathological diagnosis and basic demographic data were analyzed. Results Nonneoplastic cyst (mainly pseudocysts) was found in 66.9% of patients, neoplasms were detected in 33.1%. The mean age was significantly higher in patients with neoplasms than without neoplasm (57.06 years vs. 50.88 years, p = 0.009). Neoplastic cyst occurred more frequently in women (68.75% of women, 31.25% of men, p = 0.001), Nonneoplastic cyst was found significantly more often in men (64.95% of men, 35.05% of women, p = 0.001). Malignant tumor was found in 14.58% of neoplasms cases. Pancreatic resections in neoplastic cysts were performed in 77,08%. In patients with nonneoplastic cysts drainage operations were performed most frequently (80.41%). Conclusions Neoplastic cysts are more common in women. The average age in the group of patients with neoplasms is higher than in the group with nonneoplastic cysts. In women with pancreatic cystic lesion without history for pancreatitis, the probability of neoplasms diagnosis is high. Discussion Pancreatic cystic tumors are treated radically due to the lack of sufficiently sensitive and specific pre-operative examinations. The natural history of mucinous neoplasms (IPMN and MCN) ranges from dysplasia to cancer. There are no guidelines that could be in satisfactory way used in follow up patients with pancreatic cysts.

Malignant progression in intraductal papillary mucinous neoplasms of the pancreas:  Results of 157 patients selected for radiographic surveillance.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 152-152 ◽  
Author(s):  
Jennifer LaFemina ◽  
Sebastien Gaujoux ◽  
Michael Ian D'Angelica ◽  
William R. Jarnagin ◽  
Nora Katabi ◽  
...  
Keyword(s):  
Invasive Carcinoma ◽  
Invasive Disease ◽  
Ductal Adenocarcinoma ◽  
Branch Duct ◽  
Mucinous Neoplasms ◽  
Natural History Studies ◽  
Operative Strategies ◽  
Risk Of Malignancy

152 Background: Natural history studies suggest that intraductal papillary mucinous neoplasm (IPMN) is a field defect of pancreatic ductal instability. The risk of malignancy is well known, but it is unclear if the radiographic abnormality is the predominant site at which this progression occurs. This study analyzes the prevalence and site of pancreatic ductal adenocarcinoma (PDAC) progression in patients initially selected for radiographic surveillance. Methods: Patients evaluated for pancreatic cystic lesions between 1995-2010 were reviewed. Patients were included if they were followed for > 6 months for a cystic lesion with either a documented cyst fluid CEA >/= 200 ng/mL or pathologic confirmation of an IPMN. Results: Of the 157 patients initially selected for surveillance, 97 (62%) eventually underwent resection. The median length of surveillance prior to operation was 15 mo (range: 6-193 mo). Pathologically confirmed carcinoma in situ (high grade dysplasia, n=22) or invasive carcinoma (n=18) was identified in 40 patients. Of the 18 patients who were found to have invasive carcinoma, 10 had main duct IPMN (56%), 5 had branch duct (28%), and 3 had combined (17%). Four of the 18 patients who developed invasive cancer during surveillance (22% of those resected for carcinoma and 3% of those followed) developed PDAC in a region of the gland distinct from the radiographically identified lesion for which surveillance was recommended. Invasive carcinoma was diagnosed a median of 24 mo after the original IPMN diagnosis. During follow-up (median = 8 months from the cancer diagnosis), 1 patient died of disease, 2 are cancer-free, and 1 patient is alive with recurrence. Conclusions: In this study, 11% of patients with IPMN initially selected for surveillance developed invasive disease; 22% of those tumors arose in an area of the gland distinct from the initially identified lesion. Diagnostic and operative strategies for IPMN should consider the cancer risk in the entire gland. [Table: see text]

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