Skip to main content

Advertisement

SpringerLink
Log in

Management of intraductal papillary mucinous neoplasms

  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are being diagnosed with increasing frequency, probably due to the widespread use of cross-sectional imaging. The natural history of these tumors is still largely unknown. Several studies have shown topographical as well as biological differences between main duct and branch duct IPMNs. In the past few years, diagnostic work-up and, in particular, management of these tumors have evolved significantly. Data support the need for resection of main duct IPMNs and the possibility of nonoperative management in selected cases of branch duct tumors. In this systematic review, we analyze the most recent publications related to IPMNs, with particular emphasis on problems related to managing this challenging disease.

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 and Recommended Reading

  1. Ohashi K, Murakami Y, Murayama M, et al.: Four cases of mucus secreting pancreatic cancer. Prog Dig Endoscopy 1982, 20:348–351.

    Google Scholar 

  2. 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 

  3. Longnecker DS, Adler G, Hruban HR, et al.: Intraductal papillary mucinous neoplasms of the pancreas. In Pathology and Genetics of Tumors of the Digestive System. Edited by Hamilton SR, Aaltonen LA. London: IARC Press, 1999:237–240.

    Google Scholar 

  4. Sohn TA, Yeo CJ, Cameron JL, et al.: Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Ann Surg 2004, 239:788–797.

    Article  PubMed  Google Scholar 

  5. Salvia R, Fernández-del Castillo C, Bassi C, et al.: Mainduct intraductal papillary mucinous neoplasms of the pancreas: clinical predictors of malignancy and long-term survival following resection. Ann Surg 2004, 239:678–685.

    Article  PubMed  Google Scholar 

  6. Chari ST, Yadav D, Smyrk TC, et al.: Study of recurrence after surgical resection of intraductal papillary mucinous neoplasm of the pancreas. Gastroenterology 2002, 123:1500–1507.

    Article  PubMed  Google Scholar 

  7. Kobari M, Egawa S, Shibuya K, et al.: Intraductal papillary mucinous tumors of the pancreas comprise 2 clinical subtypes: differences in clinical characteristics and surgical management. Arch Surg 1999, 134:1131–1136.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  9. Schmidt CM, White PB, Waters JA, et al.: Intraductal papillary mucinous neoplasms: predictors of malignant and invasive pathology. Ann Surg 2007, 246:644–654.

    Article  PubMed  Google Scholar 

  10. 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 

  11. Rodriguez JR, Salvia R, Crippa S, et al.: Branch-duct intraductal papillary mucinous neoplasms: observations in 145 patients who underwent resection. Gastroenterology 2007, 133:72–79.

    Article  PubMed  Google Scholar 

  12. Pelaez-Luna M, Chari ST, Smyrk TC, et al.: Do consensus indications for resection in branch-duct intraductal papillary mucinous neoplasm predict malignancy? A study of 147 patients. Am J Gastroenterol 2007, 102:1759–1764.

    Article  PubMed  Google Scholar 

  13. Levy P, Jouannaud V, O’Toole D, et al.: Natural history of intraductal papillary mucinous tumors of the pancreas: actuarial risk of malignancy. Clin Gastroenterol Hepatol 2006, 4:460–468.

    Article  PubMed  Google Scholar 

  14. Furukawa T, Kloppel G, Adsay NV, et al.: Classification of types of intraductal papillary mucinous neoplasms of the pancreas: a consensus study. Virchows Arch 2005, 447:794–799.

    Article  PubMed  Google Scholar 

  15. Ban S, Naitoh Y, Mino-Kenudson M, et al.: Intraductal papillary mucinous neoplasm (IPMN) of the pancreas: its histopathologic difference between 2 major types. Am J Surg Pathol 2006, 30:1561–1569.

    Article  PubMed  Google Scholar 

  16. Schonleben F, Qiu W, Bruckman KC, et al.: BRAF and KRAS gene mutations in intraductal papillary mucinous neoplasm/carcinoma (IPMN/IPMC) of the pancreas. Cancer Lett 2007, 249:242–248.

    Article  PubMed  CAS  Google Scholar 

  17. Miyasaka Y, Nagai E, Yamaguchi H, et al.: The role of DNA damage checkpoint pathway in intraductal papillary mucinous neoplasms of the pancreas. Clin Cancer Res 2007, 13:4371–4377.

    Article  PubMed  CAS  Google Scholar 

  18. Yamaguchi H, Inoue T, Eguchi T, et al.: Fascin overexpression in intraductal papillary mucinous neoplasms (adenomas, borderline neoplasms, and carcinomas) of the pancreas, correlated with increased histological grade. Mod Pathol 2007, 20:552–561.

    Article  PubMed  CAS  Google Scholar 

  19. Liu MS, Yang PY, Yeh TS: Sonic hedgehog signaling pathway in pancreatic cystic neoplasms and ductal adenocarcinoma. Pancreas 2007, 34:340–346.

    Article  PubMed  CAS  Google Scholar 

  20. Ohuchida K, Mizumoto K, Fujita, et al.: Sonic hedgehog is an early developmental marker of intraductal papillary mucinous neoplasms: clinical implications of mRNA levels in pancreatic juice. J Pathol 2006, 210:42–48.

    Article  PubMed  CAS  Google Scholar 

  21. Carbognin G, Zamboni G, Pinali L, et al.: Branch duct IPMTs: value of cross-sectional imaging in the assessment of biological behavior and follow-up. Abdom Imaging 2006, 31:320–325.

    Article  PubMed  CAS  Google Scholar 

  22. Pilleul F, Rochette A, Partensky C, et al.: Preoperative evaluation of intraductal papillary mucinous tumors performed by pancreatic magnetic resonance imaging and correlated with surgical and histopathologic findings. J Magn Reson Imaging 2005, 21:237–244.

    Article  PubMed  Google Scholar 

  23. Sahani DV, Kadavigere R, Blake M, et al.: Intraductal papillary mucinous neoplasm of pancreas: multi-detector row CT with 2D curved reformations—correlation with MRCP. Radiology 2006, 238:560–569.

    Article  PubMed  Google Scholar 

  24. Song SJ, Lee JM, Kim YJ, et al.: Differentiation of intraductal papillary mucinous neoplasms from other pancreatic cystic masses: comparison of multirow-detector CT and MR imaging using ROC analysis. J Magn Reson Imaging 2007, 26:86–93.

    Article  PubMed  Google Scholar 

  25. Waters JA, Schmidt CM, Pinchot JW, et al.: CT vs MRCP: optimal classification of IPMN type and extent. J Gastrointest Surg 2007, [Epub ahead of print].

  26. Stelow EB, Stanley MW, Bardales RH, et al.: Intraductal papillary-mucinous neoplasm of the pancreas. The findings and limitations of cytologic samples obtained by endoscopic ultrasound-guided fine-needle aspiration. Am J Clin Pathol 2003, 120:398–404.

    Article  PubMed  Google Scholar 

  27. Brugge WR, Lewandrowski K, Lee-Lewandrowski E, et al.: Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology 2004, 126:1330–1336.

    Article  PubMed  Google Scholar 

  28. Michaels PJ, Brachtel EF, Bounds BC, et al.: Intraductal papillary mucinous neoplasm of the pancreas: cytologic features predict histologic grade. Cancer 2006, 108:163–173.

    Article  PubMed  Google Scholar 

  29. Sperti C, Pasquali C, Decet G, et al.: F-18-fluorodeoxy-glucose positron emission tomography in differentiating malignant from benign pancreatic cysts: a prospective study. J Gastrointest Surg 2005, 9:22–28.

    Article  PubMed  Google Scholar 

  30. Jang JY, Kim SW, Ahn YJ, et al.: Multicenter analysis of clinicopathologic features of intraductal papillary mucinous tumor of the pancreas: is it possible to predict the malignancy before surgery? Ann Surg Oncol 2005, 12:124–132.

    Article  PubMed  Google Scholar 

  31. Bassi C, Butturini G, Salvia R, et al.: Open pancreaticogastrostomy after pancreaticoduodenectomy: a pilot study. J Gastrointest Surg 2006, 10:1072–1080.

    Article  PubMed  Google Scholar 

  32. Gigot JF, Deprez P, Sempoux C, et al.: Surgical management of intraductal papillary mucinous tumors of the pancreas: the role of routine frozen section of the surgical margin, intraoperative endoscopic staged biopsies of the Wirsung duct, and pancreaticogastric anastomosis. Arch Surg 2001, 136:1256–1262.

    Article  PubMed  CAS  Google Scholar 

  33. Crippa S, Bassi C, Warshaw AL, et al.: Middle pancreatectomy: indications, operative and long-term results. Ann Surg 2007, 246:69–76.

    Article  PubMed  Google Scholar 

  34. Couvelard A, Sauvanet A, Kianmanesh R, et al.: Frozen sectioning of the pancreatic cut surface during resection of intraductal papillary mucinous neoplasms of the pancreas is useful and reliable. A prospective evaluation. Ann Surg 2005, 242:774–780.

    Article  PubMed  Google Scholar 

  35. Falconi M, Salvia R, Bassi C, et al.: Clinicopathological features and treatment of intraductal papillary mucinous tumour of the pancreas. Br J Surg 2001, 88:376–381.

    Article  PubMed  CAS  Google Scholar 

  36. White R, D’Angelica M, Katabi N, et al.: Fate of the remnant pancreas after resection of noninvasive intraductal papillary mucinous neoplasm. J Am Coll Surg 2007, 204:987–995.

    Article  PubMed  Google Scholar 

  37. Salvia R, Crippa S, Falconi M, et al.: Branch-duct intraductal papillary mucinous neoplasms of the pancreas: to operate or not to operate? Gut 2007, 56:1086–1090.

    Article  PubMed  Google Scholar 

  38. D’Angelica M, Brennan MF, Suriawinata AA, et al.: Intraductal papillary mucinous neoplasms of the pancreas. Ann Surg 2004, 239:400–408.

    Article  PubMed  Google Scholar 

  39. Choi MG, Kim SW, Han SS, et al.: High incidence of extrapancreatic neoplasms in patients with intraductal papillary mucinous neoplasms. Arch Surg 2006, 141:51–56.

    Article  PubMed  Google Scholar 

  40. Eguchi H, Ishikawa O, Ohigashi H, et al.: Patients with pancreatic intraductal papillary mucinous neoplasms are at high risk of colorectal cancer development. Surgery 2006, 139:749–754.

    Article  PubMed  Google Scholar 

  41. Riall TS, Stager VM, Nealon WH, et al.: Incidence of additional primary cancers in patients with invasive intraductal papillary mucinous neoplasms and sporadic pancreatic adenocarcinoma. J Am Coll Surg 2007, 204:803–814.

    Article  PubMed  Google Scholar 

  42. Doi R, Fujimoto K, Wada M, Imamura M: Surgical management of intraductal papillary mucinous tumor of the pancreas. Surgery 2002, 132:80–85.

    Article  PubMed  Google Scholar 

  43. 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 

  44. Choi BS, Kim TK, Kim AY, et al.: Differential diagnosis of benign and malignant intraductal papillary mucious tumors of the pancreas: MR cholangio-pancreatography and MR angiography. Korean J Radiol 2003, 4:157–162.

    Article  PubMed  Google Scholar 

  45. 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 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Massachusetts General Hospital, Wang Ambulatory Care Center (WACC) 460, 15 Parkmann Street, Boston, MA, 02114, USA

    Carlos Fernández-del Castillo

Authors
  1. Stefano Crippa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carlos Fernández-del Castillo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carlos Fernández-del Castillo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Crippa, S., Castillo, C.Fd. Management of intraductal papillary mucinous neoplasms. Curr Gastroenterol Rep 10, 136–143 (2008). https://doi.org/10.1007/s11894-008-0034-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-008-0034-7

Keywords

Search

Navigation