- Intraductal papillary mucinous neoplasms
- Pancreatic neoplasms
The introduction of the exocrine pancreatic classification by the World Health Organization and improvements in pancreatic imaging have led to an improved understanding of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas. As a result, IPMNs of the pancreas are increasingly being recognized as a separate disease entity. IPMNs are characterized by the cystic dilatation of the pancreatic duct and its branches, with papillary projections. There are three histological subtypes of IPMNs: main duct, branch duct, and mixed. The degree of atypia ranges from adenoma to frank invasive carcinoma. The lymph nodes are involved considerably less frequently than they are in pancreatic adenocarcinoma. Most patients are symptomatic at diagnosis and require a diagnostic workup similar to that for patients with pancreatic adenocarcinoma. Although some investigators continue to advocate total pancreatectomy, the evidence in support of this is decreasing. Partial pancreatectomy remains the treatment option. Intraoperative assessment of the resection surgical margins is an important component of surgical resection. Additionally, controversy also exists regarding the nature of the follow-up and the need for adjuvant chemoradiation therapy in the patient. Unlike ductal adenocarcinomas, IPMNs follow a relatively indolent course; the 5-year survival rate in patients with invasive IPMNs is 57%. A mural nodule and a main pancreatic duct diameter greater than 5 mm have been found to be predictors of malignancy.
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Peter W.T. Pisters, MD
Department of Surgical Oncology, Unit 444
The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard
Houston, TX 77230-1402 (USA)
Tel. +1 713 794 1572, Fax +1 713 792 7829, E-Mail email@example.com
Received: August 22, 2005
Revised: January 22, 2006
Number of Print Pages : 8
Number of Figures : 2, Number of Tables : 1, Number of References : 29
Medical Principles and Practice (International Journal of the Kuwait University Health Sciences Centre)
Vol. 15, No. 4, Year 2006 (Cover Date: June 2006)
Journal Editor: Al-Zaid, N.S. (Kuwait)
ISSN: 1011–7571 (print), 1423–0151 (Online)
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