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Focus on the intraductal papillary mucinous neoplasm of the pancreas.

Gallucci F, Langellotto A, De Ritis R, Uomo G - Gastroenterol Hepatol Bed Bench (2012)

Bottom Line: IMPNs do not present pathognomonic signs or symptoms.Obstruction of the main pancreatic duct system may cause abdominal pain and acute pancreatitis (single or recurrent episodes).A less aggressive surgical approach as well as the possibility of conservative management have been suggested for asymptomatic, small size (< 3-3.5 cm), branch-duct IPMN.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Unit 3, Cardarelli Hospital, Napoli, Italy.

ABSTRACT
Intraductal papillary mucinous neoplasms (IPMNs) are rare pancreatic tumours, accounting for less of 1-2% of all neoplasms of the gland. Main characteristics of IPMNs are their favourable prognosis as these pre-malignant or frankly malignant lesions are usually slow-growing tumours and radical surgery is frequently possible. According with the localization of the lesions, three different entities are identified: the main-duct IPMN (type I), the branch-duct IPMN (type II) and the mixed type (type III, involving both the main pancreatic duct and side branches). IMPNs do not present pathognomonic signs or symptoms. Obstruction of the main pancreatic duct system may cause abdominal pain and acute pancreatitis (single or recurrent episodes). The tumour 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 IPMN and assess its morphology and size. The choice between non-operative and surgical management strictly depends from the risk of malignancy and of the definitively distinction between benign and malignant IPMNs. Main-duct IPMNs are at higher risk of malignant degeneration, especially in older patients; as a consequence no doubt does not exist as concerns the need of surgery for IPMN type I and III. A less aggressive surgical approach as well as the possibility of conservative management have been suggested for asymptomatic, small size (< 3-3.5 cm), branch-duct IPMN.

No MeSH data available.


Related in: MedlinePlus

Duodenoscopy: characteristic mucin extrusion through the ampulla of Vater
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Figure 0001: Duodenoscopy: characteristic mucin extrusion through the ampulla of Vater

Mentions: IPMNs of the pancreas are characterized by intraductal proliferation of neoplastic mucinous cells, which usually form papillae, and cystic dilation of the pancreatic ducts, thus forming a clinically and macroscopically detectable mass (4). IPMN is a grossly visible (≥1 cm), mucin-producing neoplasm that arises in the main pancreatic duct and/or its branches. Two different entities were initially identified: the “main-duct” IPMN and the “branch-duct” IPMN (1, 2). Main-duct IPMNs may be associated with contemporary involvement of the side branch ducts; as a consequence, a third anatomo-clinical subtype of IMPN, named “mixed” type, has been identified (5). Macroscopically, the main-duct IPMN usually presents a dilated, full of mucin main pancreatic duct or as a cystic-like lesion along the main pancreatic duct (6). The usual location is in the proximal portion of the pancreas even if the tumour can spread to the entire main pancreatic duct. Sometimes the mucus may extrude through a bulging ampulla and it is clearly identified at duodenoscopy (Figure 1). Branch-duct IPMN more frequently involves the side branches of the uncinate process, but it can also be observed into the remaining portions of the gland with a possibility of multifocal involvement of two or more distant side branches. Branch-duct IMPNs appear as a cystic lesion communicating with a non-dilated main pancreatic duct.


Focus on the intraductal papillary mucinous neoplasm of the pancreas.

Gallucci F, Langellotto A, De Ritis R, Uomo G - Gastroenterol Hepatol Bed Bench (2012)

Duodenoscopy: characteristic mucin extrusion through the ampulla of Vater
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4017474&req=5

Figure 0001: Duodenoscopy: characteristic mucin extrusion through the ampulla of Vater
Mentions: IPMNs of the pancreas are characterized by intraductal proliferation of neoplastic mucinous cells, which usually form papillae, and cystic dilation of the pancreatic ducts, thus forming a clinically and macroscopically detectable mass (4). IPMN is a grossly visible (≥1 cm), mucin-producing neoplasm that arises in the main pancreatic duct and/or its branches. Two different entities were initially identified: the “main-duct” IPMN and the “branch-duct” IPMN (1, 2). Main-duct IPMNs may be associated with contemporary involvement of the side branch ducts; as a consequence, a third anatomo-clinical subtype of IMPN, named “mixed” type, has been identified (5). Macroscopically, the main-duct IPMN usually presents a dilated, full of mucin main pancreatic duct or as a cystic-like lesion along the main pancreatic duct (6). The usual location is in the proximal portion of the pancreas even if the tumour can spread to the entire main pancreatic duct. Sometimes the mucus may extrude through a bulging ampulla and it is clearly identified at duodenoscopy (Figure 1). Branch-duct IPMN more frequently involves the side branches of the uncinate process, but it can also be observed into the remaining portions of the gland with a possibility of multifocal involvement of two or more distant side branches. Branch-duct IMPNs appear as a cystic lesion communicating with a non-dilated main pancreatic duct.

Bottom Line: IMPNs do not present pathognomonic signs or symptoms.Obstruction of the main pancreatic duct system may cause abdominal pain and acute pancreatitis (single or recurrent episodes).A less aggressive surgical approach as well as the possibility of conservative management have been suggested for asymptomatic, small size (< 3-3.5 cm), branch-duct IPMN.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Unit 3, Cardarelli Hospital, Napoli, Italy.

ABSTRACT
Intraductal papillary mucinous neoplasms (IPMNs) are rare pancreatic tumours, accounting for less of 1-2% of all neoplasms of the gland. Main characteristics of IPMNs are their favourable prognosis as these pre-malignant or frankly malignant lesions are usually slow-growing tumours and radical surgery is frequently possible. According with the localization of the lesions, three different entities are identified: the main-duct IPMN (type I), the branch-duct IPMN (type II) and the mixed type (type III, involving both the main pancreatic duct and side branches). IMPNs do not present pathognomonic signs or symptoms. Obstruction of the main pancreatic duct system may cause abdominal pain and acute pancreatitis (single or recurrent episodes). The tumour 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 IPMN and assess its morphology and size. The choice between non-operative and surgical management strictly depends from the risk of malignancy and of the definitively distinction between benign and malignant IPMNs. Main-duct IPMNs are at higher risk of malignant degeneration, especially in older patients; as a consequence no doubt does not exist as concerns the need of surgery for IPMN type I and III. A less aggressive surgical approach as well as the possibility of conservative management have been suggested for asymptomatic, small size (< 3-3.5 cm), branch-duct IPMN.

No MeSH data available.


Related in: MedlinePlus