Skip to main content

Advertisement

SpringerLink
Log in

Ultrasonographic findings and natural history of intraductal papillary-mucinous neoplasms of the pancreas

  • Review Article
  • Published:
Journal of Medical Ultrasonics Aims and scope Submit manuscript

Abstract

It is clear that the prevalence of malignancy is high in the main-duct type of intraductal papillary-mucinous neoplasm (IPMN). Branch-duct IPMNs include several histologic conditions such as carcinoma, adenoma, and hyperplasia. Intraductal papillary adenocarcinoma and papillary adenoma are characterized by papillary protrusions and thick septum-like structures in dilated ducts as delineated by ultrasonography. A solid mass showing a mixedecho pattern in the pancreatic parenchyma is a characteristic finding of invasive types of IPMN. The international guidelines for the management of branch-duct IPMNs suggest that the appearance of symptoms attributable to the cyst, the presence of intramural nodules, a cyst size greater than 30 mm, and dilation of the main pancreatic duct (>6 mm) are indications for resection. Based on the relationship between the height of a papillary protrusion and the diameter of a cystic dilated branch as well as on histological findings, branch-duct IPMNs with papillary protrusions more than 10 mm in height as shown by imaging should be resected, and it is not adequate to differentiate carcinoma from other lesions based on the diameter of cystic branches alone. A follow-up study on branch-duct IPMNs revealed that most papillary protrusions showed a slow increase in size or development of lateral spread, and that there was no development of cancer with stromal invasion during an average follow-up of 46 months. Therefore, the presence of intramural nodules alone should not be an indication for surgery. Also, patients without papillary protrusions or thick septum-like structures are not immediate candidates for surgery. Invasive adenocarcinoma can develop at a pancreatic site different from the area of interest showing cystic changes, with such invasion possibly being multicentric. Therefore, in patients with branch-duct IPMNs, attention should be paid to the entire pancreas when performing follow-up examinations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ohashi K, Murakami Y, Maruyama M, et al. Four cases of mucous-secreting pancreatic cancer. Prog Dig Endosc 1982;20:348–351 (in Japanese).

    Google Scholar 

  2. Longnecker DS, Hruben RH, Adler G, et al. Intraductal papillary-mucinous neoplasms of the pancreas. Lyon: World Health Organization Classification of Tumors, International Agency for Research on Cancer; 2000. p. 237–240.

    Google Scholar 

  3. Tanaka M, Chari S, Adsay V, et al. International consensus guidelines for management of intraductal papillary-mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 2006;6:17–32.

    Article  PubMed  Google Scholar 

  4. Kobayashi G, Fujita N, Noda Y, et al. Mode of progression of intraductal papillary-mucinous tumor of the pancreas: analysis of patients with follow-up by EUS. J Gastroenterol 2005;40:744–751.

    Article  PubMed  Google Scholar 

  5. Kobayashi G, Fujita N, Noda Y, et al. Three morphological types of mucinous cystic tumor of the pancreas: correlation between morphological features and histological findings. In: Wakui A, Yamauchi H, Ouchi K, editors. Carcinoma of the pancreas and biliary tract. Sendai: Tohoku University Press; 1999. p. 203–212.

    Google Scholar 

  6. Kimura W, Sasahira N, Yoshikawa T, et al. Duct-ectatic type of mucin-producing tumor of the pancreas: new concept of pancreas neoplasia. Hepatogastroenterology 1996;43:692–709.

    PubMed  CAS  Google Scholar 

  7. Loftus E, Olivares-Pakzad B, Batts K, et al. Intraductal papillary-mucinous tumors of the pancreas: clinicopathological features, outcome, nomenclature. Gastroenterology 1996;110:1909–1918.

    Article  PubMed  Google Scholar 

  8. Kobayashi G, Fujita N, Lee S, et al. Correlation between ultrasonographic findings and pathological diagnosis of the mucin-producing tumor of the pancreas. Nippon Shokakibyo Gakkai Zasshi (Jpn J Gastroenterol) 1990;87:235–242 (in Japanese).

    CAS  Google Scholar 

  9. Obara T, Maguchi H, Saitoh Y, et al. Mucin-producing tumor of the pancreas: a unique clinical entity. Am J Gastroenterol 1991;86:1619–1625.

    PubMed  CAS  Google Scholar 

  10. Obara T, Maguchi H, Saitoh Y, et al. Mucin-producing tumor of the pancreas: natural history and serial pancreatogram changes. Am J Gastroenterol 1993;88:564–568.

    PubMed  CAS  Google Scholar 

  11. Cellier C, Cuillerier E, Palazzo L, et al. Intraductal papillary and mucinous tumors of the pancreas: accuracy of preoperative computed tomography, endoscopic retrograde pancreatography and endoscopic ultrasonography, and long-term outcome in a large surgical series. Gastrointest Endosc 1998;47:42–49.

    Article  PubMed  CAS  Google Scholar 

  12. Yamao K, Nakazawa S, Naitoh Y, et al. Clinicopathological study of the mucous-producing pancreatic tumors. Nippon Shokakibyo Gakkai Zasshi (Jpn J Gastroenterol) 1986;161:697–700 (in Japanese).

    Google Scholar 

  13. Morohoshi T, Kanda M, Asanuma K, et al. Intraductal papillary neoplasms of the pancreas. A clinicopathologic study of six patients. Cancer 1989;64:1329–1335.

    Article  PubMed  CAS  Google Scholar 

  14. Fujita N, Lee S, Kobayashi G, et al. Pancreatoscopy for mucous-producing pancreatic tumor. Dig Endosc 1990;2:110–115.

    Article  Google Scholar 

  15. Compagno J, Oertel JE. Mucinous cystic neoplasms of the pancreas with overt and latent malignancy (cystadenocarcinoma and cystadenoma). Am Soc Clin Pathol 1978;69:573–580.

    CAS  Google Scholar 

  16. Kloppel C. Pancreatic nonendocrine tumors. In: Kloppel C, Heitz PH, editors. Pancreatic pathology. Edinburgh: Churchill Livingstone; 1984. p. 79–113.

    Google Scholar 

  17. Yanagisawa A, Kato Y, Ohtake K, et al. Ki-ras point mutation in duct ectatic-type mucinous cystic neoplasms of the pancreas. Jpn J Cancer Res 1991;82:1057–1060.

    PubMed  CAS  Google Scholar 

  18. Kobari M, Egawa S, Shibuya K, et al. Intraductal papillary-mucinous tumors of the pancreas comprise two clinical subtypes. Arch Surg 1999;134:1131–1136.

    Article  PubMed  CAS  Google Scholar 

  19. Yamaguchi K, Ogawa Y, Chijiiwa K, et al. Mucin-hypersecreting tumors of the pancreas: assessing the grade of malignancy preoperatively. Am J Surg 1996;171:427–431.

    Article  PubMed  CAS  Google Scholar 

  20. Kitagawa Y, Unger TA, Taylor S, et al. Mucus is a predictor of better prognosis and survival in patients with intraductal papillary-mucinous tumor of the pancreas. J Gastrointest Surg 2003;7:12–19.

    Article  PubMed  Google Scholar 

  21. Sohn TA, Yeo CJ, Cameron JL, et al. Intraductal papillary-mucinous neoplasms of the pancreas: an updated experience. Ann Surg 2004;239:788–799.

    Article  PubMed  Google Scholar 

  22. Salvia R, Fernández-del Castillo C, Bassi C, et al. Main duct intraductal papillary-mucinous neoplasms of the pancreas: clinical predictors of malignancy and long-term survival following resection. Ann Surg 2004;239:678–687.

    Article  PubMed  Google Scholar 

  23. Chari S, Yadav D, Smyrk TC, et al. Study of recurrence after surgical resection of intraductal papillary-mucinous tumors of the pancreas. Gastroenterology 2002;123:1500–1507.

    Article  PubMed  Google Scholar 

  24. Kobayashi G, Fujita N, Noda Y, et al. Histologic features and prognosis of mucinous cystic tumor of the pancreas. In: Wakui A, Yamauchi H, Ouchi K, editors. Carcinoma of the pancreas and biliary tract. Sendai: Tohoku University Press; 1999. p. 213–218.

    Google Scholar 

  25. Maguchi H. Clinicopathological and diagnostic study of mucin-producing pancreatic tumors. Jpn J Gastroenterol 1994;91:1003–1015 (in Japanese with English abstract).

    CAS  Google Scholar 

  26. Sugiyama M, Atomi Y. Intraductal papillary-mucinous tumors of the pancreas: imaging studies and treatment strategies. Ann Surg 1998;228:685–691.

    Article  PubMed  CAS  Google Scholar 

  27. Koito K, Namieno T, Ichimura T, et al. Mucin-producing pancreatic tumors: comparison of MR cholangiopancreatography with endoscopic retrograde cholangiopancreatography. Radiology 1998;208:231–237.

    PubMed  CAS  Google Scholar 

  28. Kubo H, Chijiiwa Y, Akahoshi K, et al. Intraductal papillary-mucinous tumors of the pancreas: differential diagnosis between benign and malignant tumors by endoscopic ultrasonography. Am J Gastroenterol 2001;96:1429–1434.

    Article  PubMed  CAS  Google Scholar 

  29. Koito K, Namieno T, Nagakawa T, et al. Solitary cystic tumor of the pancreas: EUS-pathologic correlation. Gastrointest Endosc 1997;45:268–276.

    Article  PubMed  CAS  Google Scholar 

  30. Inui K, Nakazawa S, Yoshino J, et al. Mucin-producing tumor of the pancreas: intraluminal ultrasonography. Hepatogastroenterology 1998;45:1996–2000.

    PubMed  CAS  Google Scholar 

  31. Sugiyama M, Atomi Y, Saito M. Intraductal papillary tumors of the pancreas: evaluation with endoscopic ultrasonography. Gastrointest Endosc 1998;48:164–171.

    Article  PubMed  CAS  Google Scholar 

  32. Yamao K, Ohashi K, Nakamura T, et al. Evaluation of various imaging methods in the differential diagnosis of intraductal papillary-mucinous tumor (IPMT) of the pancreas. Hepatogastroenterology 2001;48:962–966.

    PubMed  CAS  Google Scholar 

  33. Kobayashi G, Fujita N, Noda Y, et al. Study of cases of mucin-producing tumor of the pancreas showing penetration of other organs. Nippon Shokakibyo Gakkai Zasshi (Jpn J Gastroenterol) 1993;90:3081–3089 (in Japanese).

    CAS  Google Scholar 

  34. Yamaguchi K, Chijiwa K, Shimizu S, et al. Comparison of endoscopic retrograde and magnetic resonance cholangiopancreatography in the surgical diagnosis of pancreatic diseases. Am J Surg 1998;175:203–208.

    Article  PubMed  CAS  Google Scholar 

  35. Procacci C, Carbognin G, Accodini S, et al. CT features of malignant mucinous cystic tumor of the pancreas. Eur Radiol 2001;11:1626–1630.

    Article  PubMed  CAS  Google Scholar 

  36. Terris B, Ponsot P, Paye F, et al. Intraductal papillary-mucinous tumors of the pancreas confined to secondary ducts show less aggressive pathologic features as compared with those involving the main pancreatic duct. Am J Surg Pathol 2000;24:1372–1377.

    Article  PubMed  CAS  Google Scholar 

  37. Doi R, Fujimoto K, Wada M, et al. Surgical management of intraductal papillary-mucinous tumor of the pancreas. Surgery 2002;132:80–85.

    Article  PubMed  Google Scholar 

  38. Matsumoto T, Aramaki M, Yada K, et al. Optimal management of the branch duct-type intraductal papillary-mucinous neoplasms of the pancreas. J Clin Gastroenterol 2003;36:261–265.

    Article  PubMed  Google Scholar 

  39. Sugiyama M, Izumisato Y, Abe N, et al. Predictive factors for malignancy in intraductal papillary-mucinous tumors of the pancreas. Br J Surg 2003;90:1244–1249.

    Article  PubMed  CAS  Google Scholar 

  40. Irie H, Yoshimitsu K, Aibe H, et al. Natural history of pancreatic intraductal papillary-mucinous tumor of branch duct type: follow-up study by magnetic resonance cholangiopancreatography. J Comput Assist Tomogr 2004;28:117–122.

    Article  PubMed  Google Scholar 

  41. Wakabayashi T, Kawaura Y, Morimoto H, et al. Clinical management of intraductal papillary-mucinous tumors of the pancreas based on imaging findings. Pancreas 2001;22:370–377.

    Article  PubMed  CAS  Google Scholar 

  42. Yamaguchi K, Sugitani A, Chijiiwa K, et al. Intraductal papillary-mucinous tumor of the pancreas: assessing the grade of malignancy from natural history. Am Surg 2001;67:400–406.

    PubMed  CAS  Google Scholar 

  43. Kobayashi G, Fujita N, Noda Y, et al. Patients with intraductal mucinous neoplasms of the pancreas: resection or follow-up? Endosc Dig 2007;19:1101–1110 (in Japanease with English abstract).

    Google Scholar 

  44. Collins VP, Loeffler RK, Tivey H. Observations on growth rates of human tumors. Am J Roentgenol 1956;76:988–1000.

    CAS  Google Scholar 

  45. Taki T, Goto H, Naitoh Y, et al. Diagnosis of mucin-producing tumor of the pancreas with an intraductal ultrasonographic system. J Ultrasound Med 1997;16:1–6.

    PubMed  CAS  Google Scholar 

  46. Inui K, Nakazawa S, Yoshino J, et al. Mucin-producing tumor of the pancreas: intraductal ultrasonography. Hepatogastroenterology 1998;45:1996–2000.

    PubMed  CAS  Google Scholar 

  47. Nakamura Y, Nakazawa S, Yamao K, et al. Evaluation of intraductal ultrasonography of the pancreas for intraductal papillary tumor. Gastroenterol Endosc 1997;39:42–51 (in Japanese with English abstract).

    Google Scholar 

  48. Ito K, Fujita N, Noda Y, et al. Clinical significance of intraductal ultrasonography for diagnosis of intraductal papillary-mucinous neoplasm of the pancreas. Dig Endosc 2006;18:S73–S77.

    Article  Google Scholar 

  49. Fujita N, Yokohata K, Maguchi H, et al. Newly developed ultrasonic probe with ropeway system for transpapillary intraductal ultrasonography of the bilio-pancreatic ductal system. Dig Endosc 2000;12:250–254.

    Article  Google Scholar 

  50. Uehara H, Nakaizumi A, Tatsuta M, et al. Diagnosis of carcinoma in situ of the pancreas by peroral pancreatoscopy and pancreatoscopic cytology. Cancer 1997;79:454–461.

    Article  PubMed  CAS  Google Scholar 

  51. Yamao K, Ohashi K, Nakamura T, et al. Efficacy of peroral pancreatoscopy in the diagnosis of pancreatic diseases. Gastrointest Endosc 2003;57:205–209.

    Article  PubMed  Google Scholar 

  52. Igarashi Y, Miura T, Okano N, et al. Endoscopic diagnosis of intraductal papillary-mucinous neoplasm using peroral pancreatoscopy with narrow band imaging. Dig Endosc 2007;19:S105–S108

    Article  Google Scholar 

  53. Hara T, Yamaguchi T, Ishihara T, et al. Diagnosis and patient management of intraductal papillary-mucinous tumor of the pancreas by using peroral pancreatoscopy and intraductal ultrasonography. Gastroenterology 2002;122:34–43.

    Article  PubMed  Google Scholar 

  54. Izawa T, Obara T, Tanno S, et al. Clonality and field cancerization in intraductal papillary-mucinous tumors of the pancreas. Cancer 2001;92:1807–1807.

    Article  PubMed  CAS  Google Scholar 

  55. Yamaguchi K, Ohuchida J, Ohtsuka T, et al. Intraductal papillary-mucinous tumor of the pancreas concomitant with ductal carcinoma of the pancreas. Pancreatology 2002;2:484–490.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Sendai City Medical Center, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan

    Go Kobayashi, Naotaka Fujita, Yutaka Noda, Takashi Obana & Osamu Takasawa

Authors
  1. Go Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Naotaka Fujita
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yutaka Noda
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takashi Obana
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Osamu Takasawa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Go Kobayashi.

About this article

Cite this article

Kobayashi, G., Fujita, N., Noda, Y. et al. Ultrasonographic findings and natural history of intraductal papillary-mucinous neoplasms of the pancreas. J Med Ultrasonics 35, 85–96 (2008). https://doi.org/10.1007/s10396-008-0188-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10396-008-0188-9

Keywords

Search

Navigation