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Intraductal Papillary Mucinous Neoplasms

Intraductal Papillary Mucinous Neoplasms. Intraductal Papillary Mucinous Neoplasm. Grogan JR et al. AJR 176:921-9.2001. IPMN. Spectrum: IPMN adenoma, IPMN borderline lesion, Intraductal papillary mucinous carcinoma. Adenoma. Carcinoma in situ. Invasive carcinoma. IPMN. Main duct type.

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Intraductal Papillary Mucinous Neoplasms

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  1. Intraductal Papillary Mucinous Neoplasms

  2. Intraductal Papillary Mucinous Neoplasm Grogan JR et al. AJR 176:921-9.2001.

  3. IPMN Spectrum: IPMN adenoma, IPMN borderline lesion, Intraductal papillary mucinous carcinoma Adenoma Carcinoma in situ Invasive carcinoma

  4. IPMN Main duct type Side branch type Grogan JR et al. AJR 176:921-9,2001.

  5. Main duct type IPMN borderline Path: IPMN borderline with no invasive carcinoma

  6. Branch type IPMN adenoma Path : 1 cm branch duct type IPMN adenoma. No invasive carcinoma

  7. Branch type IPMN adenoma Path: 1.2 cm IPMN adenoma. No invasive carcinoma

  8. Combined type IPMN Path: IPMN borderline lesions. No invasive carcinoma

  9. IPMN • Study: 43 pts with IPMN and surgical follow-up. • 13 pts with side branch duct type: • 2 with carcinoma in situ • 0 with invasive carcinoma • 30 pts with main branch duct type: • 6 with carcinoma in situ • 11 with invasive carcinoma Terris, B et al. Am J Surg Pathol 24:1372-1377,2000.

  10. Imaging features predictive of invasive carcinoma • Main pancreatic duct involvement and/or dilatation • Diffuse or multifocal involvement • Presence of large mural nodule or solid mass • Large size of mass • Obstruction of the CBD

  11. Main pancreatic duct involvement Path: ductal adenocarcinoma associated with IPMN with carcinoma in situ. Invasion of duodenal wall and distal CBD. 4 of 10 regional nodes with mets

  12. Diffuse or multifocal involvement Pancreatic duct dilatation affecting > 50% of the extent Lesions involving more than one segment (uncinate process, head, body, tail) Path: IPMN with extensive carcinoma in situ and moderately differentiated ductal adenocarcinoma.

  13. Presence of large (3 mm) mural nodule or solid mass Path: invasive poorly differentiated adenocarcinoma with anaplastic features arising in association with IPMN. Splenic vein invasion. Mets in 1 of 14 lymph nodes

  14. Presence of large (3 mm) mural nodule or solid mass Path: infiltrating moderately differentiated adenocarcinoma of the pancreas Associated with IPMN. Mets in 2 of 10 lymph nodes

  15. Large size of mass • “Large”: various definitions in different studies • > 2 cm: 82% sensitivity and 90% specificity for malignancy • > 3 cm: all cases with malignancy (carcinoma in situ and invasive) • > 5 cm: 54% sensitivity and 94% specificity for invasive carcinoma Path: colloid carcinoma arising in IPMN. Mucinous and necrotic debris with calcifications in mass. Peripancreatic extension and positive nodes.

  16. Obstruction of the CBD • Obstruction caused by direct cancer invasion of the CBD and/or • flow and retention of mucin in the CBD. • > 15 mm or presence of biliary stent: 60% sens and 95% spec • for invasive carcinoma. Path: infiltrating moderately differentiated ductal adenocarcinoma arising in IPMN

  17. IPMN: summary • One of several types of pancreatic cystic lesions • Spectrum: adenoma, borderline, invasive carcinoma • 3 types: side branch, mixed, main duct • Multispecialty approach and follow up often needed • Surgery can be curative

  18. IPMN summary • Predictive features of invasive carcinoma • Main duct involvement and/or dilatation • Diffuse or multifocal involvement • Mural nodule or associated solid mass • Large size of the mass • Obstruction of the CDB

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