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Ohtsuka T, Fernandez-Del Castillo C, Furukawa T, Hijioka S, Jang JY, Lennon AM, Miyasaka Y, Ohno E, Salvia R, Wolfgang CL, Wood LD. International evidence-based Kyoto guidelines for the management of intraductal papillary mucinous neoplasm of the pancreas. Pancreatology 2024; 24:255-270. [PMID: 38182527 DOI: 10.1016/j.pan.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/14/2023] [Accepted: 12/22/2023] [Indexed: 01/07/2024]
Abstract
This study group aimed to revise the 2017 international consensus guidelines for the management of intraductal papillary mucinous neoplasm (IPMN) of the pancreas, and mainly focused on five topics; the revision of high-risk stigmata (HRS) and worrisome features (WF), surveillance of non-resected IPMN, surveillance after resection of IPMN, revision of pathological aspects, and investigation of molecular markers in cyst fluid. A new development from the prior guidelines is that systematic reviews were performed for each one of these topics, and published separately to provide evidence-based recommendations. One of the highlights of these new "evidence-based guidelines" is to propose a new management algorithm, and one major revision is to include into the assessment of HRS and WF the imaging findings from endoscopic ultrasound (EUS) and the results of cytological analysis from EUS-guided fine needle aspiration technique, when this is performed. Another key element of the current guidelines is to clarify whether lifetime surveillance for small IPMNs is required, and recommends two options, "stop surveillance" or "continue surveillance for possible development of concomitant pancreatic ductal adenocarcinoma", for small unchanged BD-IPMN after 5 years surveillance. Several other points are also discussed, including identifying high-risk features for recurrence in patients who underwent resection of non-invasive IPMN with negative surgical margin, summaries of the recent observations in the pathology of IPMN. In addition, the emerging role of cyst fluid markers that can aid in distinguishing IPMN from other pancreatic cysts and identify those IPMNs that harbor high-grade dysplasia or invasive carcinoma is discussed.
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Affiliation(s)
- Takao Ohtsuka
- Department of Digestive Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
| | | | - Toru Furukawa
- Department of Investigative Pathology, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Susumu Hijioka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Jin-Young Jang
- Division of Hepatobiliary-Pancreatic Surgery, Departments of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Anne Marie Lennon
- Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Yoshihiro Miyasaka
- Department of Surgery, Fukuoka University Chikushi Hospital, and Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Eizaburo Ohno
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Aichi, Japan
| | - Roberto Salvia
- Department of Surgery, Dentistry, Paediatrics and Gynaecology University of Verona, Verona, Italy
| | | | - Laura D Wood
- Departments of Pathology and Oncology, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Mishima T, Takano S, Takayashiki T, Kuboki S, Suzuki D, Sakai N, Hosokawa I, Konishi T, Nishino H, Nakada S, Kouchi Y, Kishimoto T, Ohtsuka M. Serum elastase-1 predicts malignancy in intraductal papillary mucinous neoplasm of the pancreas. Pancreatology 2024; 24:93-99. [PMID: 38102054 DOI: 10.1016/j.pan.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND The indication for surgical resection of intraductal papillary mucinous neoplasms (IPMNs) is defined by imaging features, such as mural nodules. Although carbohydrate antigen (CA) 19-9 was selected as a parameter for worrisome features, no serum biomarkers were considered when deciding on surgical indications in the latest international consensus guideline. In this study, we assessed whether clinical factors, imaging findings, and serum biomarkers are useful in predicting malignant IPMNs. METHODS A total of 234 resected IPMN cases in Chiba University Hospital from July 2005 to December 2021 were retrospectively analyzed. RESULTS Among the 234 patients with resected IPMNs diagnosed by preoperative imaging, 117 were diagnosed with malignant pathologies (high-grade dysplasia and invasive IPMNs) according to the histological classification. In the multivariate analysis, cyst diameter ≥30 mm; p = 0.035), enhancing mural nodules on multidetector computed tomography (≥5 mm; p = 0.018), and high serum elastase-1 (≥230 ng/dl; p = 0.0007) were identified as independent malignant predictors, while CA19-9 was not. Furthermore, based on the receiver operator characteristic curve analyses, elastase-1 was superior to CA19-9 for predicting malignant IPMNs. Additionally, high serum elastase-1 levels (≥230 ng/dl; p = 0.0093) were identified as independent predictors of malignant IPMNs in patients without mural nodules on multidetector computed tomography (MDCT) in multivariate analysis. CONCLUSION The serum elastase-1 level was found to be a potentially useful biomarker for predicting malignant IPMNs.
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Affiliation(s)
- Takashi Mishima
- Department of General Surgery, Chiba University, Graduate School of Medicine, Chiba, Japan
| | - Shigetsugu Takano
- Department of General Surgery, Chiba University, Graduate School of Medicine, Chiba, Japan
| | - Tsukasa Takayashiki
- Department of General Surgery, Chiba University, Graduate School of Medicine, Chiba, Japan
| | - Satoshi Kuboki
- Department of General Surgery, Chiba University, Graduate School of Medicine, Chiba, Japan
| | - Daisuke Suzuki
- Department of General Surgery, Chiba University, Graduate School of Medicine, Chiba, Japan
| | - Nozomu Sakai
- Department of General Surgery, Chiba University, Graduate School of Medicine, Chiba, Japan
| | - Isamu Hosokawa
- Department of General Surgery, Chiba University, Graduate School of Medicine, Chiba, Japan
| | - Takanori Konishi
- Department of General Surgery, Chiba University, Graduate School of Medicine, Chiba, Japan
| | - Hitoe Nishino
- Department of General Surgery, Chiba University, Graduate School of Medicine, Chiba, Japan
| | - Shinichiro Nakada
- Department of General Surgery, Chiba University, Graduate School of Medicine, Chiba, Japan
| | - Yusuke Kouchi
- Department of Molecular Pathology, Chiba University, Graduate School of Medicine, Chiba, Japan
| | - Takashi Kishimoto
- Department of Molecular Pathology, Chiba University, Graduate School of Medicine, Chiba, Japan
| | - Masayuki Ohtsuka
- Department of General Surgery, Chiba University, Graduate School of Medicine, Chiba, Japan.
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Yoshizaki Y, Gohda Y, Inagaki F, Kataoka A, Takemura N, Miyazaki H, Igari T, Kiyomatsu T, Yano H, Kokudo N. A case of pseudomyxoma peritonei arising from a perforated intraductal papillary mucinous neoplasm that underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Clin J Gastroenterol 2024; 17:188-197. [PMID: 37980306 DOI: 10.1007/s12328-023-01890-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/25/2023] [Indexed: 11/20/2023]
Abstract
Pseudomyxoma peritonei (PMP) of pancreatic origin arising from an intraductal papillary mucinous neoplasm (IPMN) is rare. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has been established as the optimal treatment for PMP. However, the benefits and safety of CRS with HIPEC for treating PMP of pancreatic origin remain unclear. Herein, we describe a case of PMP of pancreatic origin that was treated with CRS and HIPEC without postoperative complications. A 75-year-old woman was referred to our department. Computed tomography (CT) revealed a multilocular cystic tumor in the pancreatic tail, notable mucinous ascites in the abdominal cavity, and scalloping of the liver and spleen. CT did not reveal the appendix, and the ovaries were normal in size. The patient was diagnosed with PMP of pancreatic origin, and CRS and HIPEC were performed. Intraoperatively, the pancreatic tumor was perforated, and there was a large amount of mucinous ascites. We performed distal pancreatectomy in addition to CRS and HIPEC, with no intraoperative complications. The postoperative course was uneventful, and the patient survived after 6 months without recurrence. CRS with HIPEC may be a feasible treatment option for PMP of pancreatic origin.
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Affiliation(s)
- Yuhi Yoshizaki
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
| | - Yoshimasa Gohda
- Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan.
| | - Fuyuki Inagaki
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
| | - Atsuko Kataoka
- Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
| | - Nobuyuki Takemura
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
| | - Hideki Miyazaki
- Department of Pathology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
| | - Toru Igari
- Department of Pathology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
| | - Tomomichi Kiyomatsu
- Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
| | - Hideaki Yano
- Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
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Kim J, Park S, Yim E, Park SH, Kang CM. Margin-negative minimally invasive pancreatoduodenectomy following FOLFIRINOX neoadjuvant chemotherapy in invasive intraductal papillary mucinous neoplasm of pancreas: a case report. KOREAN JOURNAL OF CLINICAL ONCOLOGY 2023; 19:80-83. [PMID: 38229493 DOI: 10.14216/kjco.23014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 12/26/2023] [Indexed: 01/18/2024]
Abstract
This study shows a case of neoadjuvant chemotherapy application for the management of a 34-year-old male patient diagnosed with invasive intraductal papillary mucinous neoplasm (IPMN), for which curative margin-negative resection initially seemed challenging. Five cycles of the FOLFIRINOX regimen (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) were administered preoperatively, resulting in a significant reduction of the intraductal mass size and deformity of the main vessels. The patient subsequently underwent a successful robotic pylorus-preserving pancreatoduodenectomy. Postoperatively, the patient received adjuvant chemotherapy with FOLFIRINOX, and after 5 months, showed no signs of tumor recurrence or specific complications. These findings suggest that neoadjuvant therapy can be a potentially effective strategy even in advanced invasive IPMN. Further research is necessary to establish guidelines for its application.
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Affiliation(s)
- Jinho Kim
- Yonsei University College of Medicine, Seoul, Korea
| | - Seokjin Park
- Yonsei University College of Medicine, Seoul, Korea
| | - Eunsang Yim
- Yonsei University College of Medicine, Seoul, Korea
| | - Su Hyeong Park
- Division of HBP Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
| | - Chang Moo Kang
- Division of HBP Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
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Revoredo Rego F, Reaño Paredes G, de Vinatea de Cárdenas J, Herrera Chávez G, Kometter Barrios F, Arenas Gamio J. Intraductal papillary mucinous neoplasm of pancreas: Clinicopathological features and long-term survival after surgical resection. Cir Esp 2023; 101:736-745. [PMID: 36716959 DOI: 10.1016/j.cireng.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 10/04/2022] [Accepted: 10/30/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Intraductal papillary mucinous neoplasm (IPMN) of the pancreas can progress from low-grade dysplasia to high-grade dysplasia and invasive carcinoma. METHODS In this single-center retrospective series, we analyze the clinicopathological features and long-term follow up of patients who underwent pancreatic resection for IPMN, from January 2009 to December 2019. RESULTS 31 patients were diagnosed with IPMN: 9 males and 22 females. Mean age was 67 years. Twenty-seven patients (87%) were symptomatic. Seven patients had main duct IPMN, 11 branch-type IPMN and 13 mixed-type IPMN. High-risk stigmata were found in 20 patients (64.5%) and worrisome features in 10 patients (32.2%). Thirteen patients (41.9%) had an associated invasive carcinoma, 4 (12.9%) high-grade dysplasia and 14 (45.2%) low-grade dysplasia. The follow-up was from 2 to 12 years. Median survival for patients with IPMN and associated invasive carcinoma was 45.8 months, and disease-free survival was 40.8 months. CONCLUSIONS IPMN had a higher prevalence in females, mostly symptomatic and high incidence of associated invasive carcinoma with branch type. The 5-year survival was good even with associated invasive carcinoma.
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Affiliation(s)
- Fernando Revoredo Rego
- Servicio de Cirugía de Páncreas, Bazo y Retroperitoneo, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru.
| | - Gustavo Reaño Paredes
- Servicio de Cirugía de Páncreas, Bazo y Retroperitoneo, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru
| | - José de Vinatea de Cárdenas
- Servicio de Cirugía de Páncreas, Bazo y Retroperitoneo, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru
| | - Guillermo Herrera Chávez
- Servicio de Cirugía de Páncreas, Bazo y Retroperitoneo, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru
| | - Fritz Kometter Barrios
- Servicio de Cirugía de Páncreas, Bazo y Retroperitoneo, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru
| | - José Arenas Gamio
- Servicio de Anatomía Patológica, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru
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Veron Sanchez A, Santamaria Guinea N, Cayon Somacarrera S, Bennouna I, Pezzullo M, Bali MA. Rare Solid Pancreatic Lesions on Cross-Sectional Imaging. Diagnostics (Basel) 2023; 13:2719. [PMID: 37627978 PMCID: PMC10453474 DOI: 10.3390/diagnostics13162719] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
Several solid lesions can be found within the pancreas mainly arising from the exocrine and endocrine pancreatic tissue. Among all pancreatic malignancies, the most common subtype is pancreatic ductal adenocarcinoma (PDAC), to a point that pancreatic cancer and PDAC are used interchangeably. But, in addition to PDAC, and to the other most common and well-known solid lesions, either related to benign conditions, such as pancreatitis, or not so benign, such as pancreatic neuroendocrine neoplasms (pNENs), there are solid pancreatic lesions considered rare due to their low incidence. These lesions may originate from a cell line with a differentiation other than exocrine/endocrine, such as from the nerve sheath as for pancreatic schwannoma or from mesenchymal cells as for solitary fibrous tumour. These rare solid pancreatic lesions may show a behaviour that ranges in a benign to highly aggressive malignant spectrum. This review includes cases of an intrapancreatic accessory spleen, pancreatic tuberculosis, solid serous cystadenoma, solid pseudopapillary tumour, pancreatic schwannoma, purely intraductal neuroendocrine tumour, pancreatic fibrous solitary tumour, acinar cell carcinoma, undifferentiated carcinoma with osteoclastic-like giant cells, adenosquamous carcinoma, colloid carcinoma of the pancreas, primary leiomyosarcoma of the pancreas, primary and secondary pancreatic lymphoma and metastases within the pancreas. Therefore, it is important to determine the correct diagnosis to ensure optimal patient management. Because of their rarity, their existence is less well known and, when depicted, in most cases incidentally, the correct diagnosis remains challenging. However, there are some typical imaging features present on cross-sectional imaging modalities that, taken into account with the clinical and biological context, contribute substantially to achieve the correct diagnosis.
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Affiliation(s)
- Ana Veron Sanchez
- Hôpital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium; (I.B.)
| | | | | | - Ilias Bennouna
- Hôpital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium; (I.B.)
| | - Martina Pezzullo
- Hôpital Universitaire de Bruxelles, Hôpital Erasme, 1070 Brussels, Belgium
| | - Maria Antonietta Bali
- Hôpital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium; (I.B.)
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Vlăduţ C, Bilous D, Ciocîrlan M. Real-Life Management of Pancreatic Cysts: Simplified Review of Current Guidelines. J Clin Med 2023; 12:4020. [PMID: 37373713 DOI: 10.3390/jcm12124020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Pancreatic cysts are becoming a popular diagnostic tool due to the increased availability of high-quality cross-sectional imaging. Pancreatic cystic lesions constitute closed, liquid-containing cavities, which are either neoplastic or non-neoplastic. While serous lesions often follow a benign course, mucinous lesions can hide carcinoma and, therefore, require different management. Moreover, all cysts should be considered mucinous until proven otherwise, thus limiting the errors in managing these entities. Due to the need for high contrast soft tissue imaging, magnetic resonance imaging represents an elective, non-invasive diagnostic tool. Endoscopic ultrasound (EUS) has started gaining more prominence with regard to the proper diagnosis and management of pancreatic cysts, offering quality information with minimal risks. Enabling both the acquisition of endoscopic images of the papilla and the endosonographic high-quality evaluation of septae, mural nodules along with the vascular patterns of the lesion contribute to a definitive diagnosis. Moreover, the possibility of obtaining cytological or histological samples could become mandatory in the foreseeable future, allowing for more precise molecular testing. Future research should focus on detecting methods to quickly diagnose high-grade dysplasia or early cancer for patients with pancreatic cysts, thus allowing time for appropriate treatment and avoiding surgical overtreatment or over surveillance in selected cases.
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Affiliation(s)
- Cătălina Vlăduţ
- Department 5, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Gastroenterology Department, "Prof Dr Agrippa Ionescu" Emergency Hospital, 011356 Bucharest, Romania
| | - Dana Bilous
- Gastroenterology Department, "Prof Dr Agrippa Ionescu" Emergency Hospital, 011356 Bucharest, Romania
| | - Mihai Ciocîrlan
- Department 5, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Gastroenterology Department, "Prof Dr Agrippa Ionescu" Emergency Hospital, 011356 Bucharest, Romania
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8
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Triantopoulou C, Gourtsoyianni S, Karakaxas D, Delis S. Intraductal Papillary Mucinous Neoplasm of the Pancreas: A Challenging Diagnosis. Diagnostics (Basel) 2023; 13:2015. [PMID: 37370909 DOI: 10.3390/diagnostics13122015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/31/2023] [Accepted: 06/04/2023] [Indexed: 06/29/2023] Open
Abstract
Intraductal papillary mucinous neoplasm of the pancreas (IPMN) was classified as a distinct entity from mucinous cystic neoplasm by the WHO in 1995. It represents a mucin-producing tumor that originates from the ductal epithelium and can evolve from slight dysplasia to invasive carcinoma. In addition, different aspects of tumor progression may be seen in the same lesion. Three types are recognized, the branch duct variant, the main duct variant, which shows a much higher prevalence for malignancy, and the mixed-type variant, which combines branch and main duct characteristics. Advances in cross-sectional imaging have led to an increased rate of IPMN detection. The main imaging characteristic of IPMN is the dilatation of the pancreatic duct without the presence of an obstructing lesion. The diagnosis of a branch duct IPMN is based on the proof of its communication with the main pancreatic duct on MRI-MRCP examination. Early identification by imaging of the so-called worrisome features or predictors for malignancy is an important and challenging task. In this review, we will present recent imaging advances in the diagnosis and characterization of different types of IPMNs, as well as imaging tools available for early recognition of worrisome features for malignancy. A critical appraisal of current IPMN management guidelines from both a radiologist's and surgeon's perspective will be made. Special mention is made of complications that might arise during the course of IPMNs as well as concomitant pancreatic neoplasms including pancreatic adenocarcinoma and pancreatic endocrine neoplasms. Finally, recent research on prognostic and predictive biomarkers including radiomics will be discussed.
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Affiliation(s)
| | - Sofia Gourtsoyianni
- 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 11528 Athens, Greece
| | - Dimitriοs Karakaxas
- Department of Surgery, Konstantopouleio General Hospital, 14233 Athens, Greece
| | - Spiros Delis
- Department of Surgery, Konstantopouleio General Hospital, 14233 Athens, Greece
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Kitasaki N, Inoue M, Abe T, Kohata A, Kochi M, Hotta R, Kobayashi T, Ohdan H, Toyota K, Takahashi T. Intracystic papillary neoplasm diagnosis following an extended cholecystectomy: a case report … and literature review. Oxf Med Case Reports 2023; 2023:omad051. [PMID: 37377712 PMCID: PMC10292644 DOI: 10.1093/omcr/omad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/05/2023] [Accepted: 04/24/2023] [Indexed: 06/29/2023] Open
Abstract
We report a case of intracystic papillary neoplasms (ICPN) that was difficult to differentiate from adenocarcinoma of the gallbladder. A 64-year-old man visited our hospital for an examination of gallbladder tumors. At the preoperative examination, the tumor was revealed a papillary type of tumor in the body of the gallbladder without the findings that without the findings that suggested the tumor invasion into the deep subserosal layer. The patient underwent an extended cholecystectomy. Papillary lesions were observed mainly in the body of the gallbladder, with flattened elevated lesions at the gallbladder fundus. Within each of these tumors, cells corresponding to intraepithelial adenocarcinoma were irregularly interspersed, leading to a diagnosis of ICPN. The patient is currently undergoing follow-up with no recurrence postoperatively. The prognosis of ICPN is generally good; however, preoperative diagnosis remains challenging. Therefore, a treatment plan for gallbladder cancer should be applied.
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Affiliation(s)
- Nao Kitasaki
- Correspondence address. 513 Jike Saijyou Higashihiroshima Hiroshima Japan. Tel: +81 824232176; Fax: +81 824232176; E-mail:
| | - Masashi Inoue
- Department of Gastroenterological and Surgery, National Hospital Organization Higashihiroshima Medical Center, Hiroshima, Japan
| | - Tomoyuki Abe
- Department of Gastroenterological and Surgery, National Hospital Organization Higashihiroshima Medical Center, Hiroshima, Japan
| | - Akihiro Kohata
- Department of Gastroenterological and Surgery, National Hospital Organization Higashihiroshima Medical Center, Hiroshima, Japan
| | - Masatoshi Kochi
- Department of Gastroenterological and Surgery, National Hospital Organization Higashihiroshima Medical Center, Hiroshima, Japan
| | - Ryuichi Hotta
- Department of Gastroenterological and Surgery, National Hospital Organization Higashihiroshima Medical Center, Hiroshima, Japan
| | - Tsuyoshi Kobayashi
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuhiro Toyota
- Department of Gastroenterological and Surgery, National Hospital Organization Higashihiroshima Medical Center, Hiroshima, Japan
| | - Tadateru Takahashi
- Department of Gastroenterological and Surgery, National Hospital Organization Higashihiroshima Medical Center, Hiroshima, Japan
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10
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Mormul A, Włoszek E, Nowoszewska J, Fudalej M, Budzik M, Badowska-Kozakiewicz A, Deptała A. Rare Non-Neuroendocrine Pancreatic Tumours. Cancers (Basel) 2023; 15:cancers15082216. [PMID: 37190144 DOI: 10.3390/cancers15082216] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 03/30/2023] [Accepted: 04/07/2023] [Indexed: 05/17/2023] Open
Abstract
The most common tumour of the pancreas is ductal adenocarcinoma (PDAC). It remains one of the most lethal non-neuroendocrine solid tumours despite the use of a multi-approach strategy. Other, less-common neoplasms, which are responsible for 15% of pancreatic lesions, differ in treatment and prognosis. Due to the low incidence rate, there is a lack of information about the rarest pancreatic tumours. In this review, we described six rare pancreatic tumours: intraductal papillary mucinous neoplasm (IPMN), mucinous cystadenoma (MCN), serous cystic neoplasm (SCN), acinar cell carcinoma (ACC), solid pseudopapillary neoplasm (SPN) and pancreatoblastoma (PB). We distinguished their epidemiology, clinical and gross features, covered the newest reports about courses of treatment and systematised differential diagnoses. Although the most common pancreatic tumour, PDAC, has the highest malignant potential, it is still essential to properly classify and differentiate less-common lesions. It is vital to continue the search for new biomarkers, genetic mutations and the development of more specific biochemical tests for determining malignancy in rare pancreatic neoplasms.
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Affiliation(s)
- Agata Mormul
- Students' Scientific Organization of Cancer Cell Biology, Department of Oncology Propaedeutics, Medical University of Warsaw, 01-445 Warsaw, Poland
| | - Emilia Włoszek
- Students' Scientific Organization of Cancer Cell Biology, Department of Oncology Propaedeutics, Medical University of Warsaw, 01-445 Warsaw, Poland
| | - Julia Nowoszewska
- Students' Scientific Organization of Cancer Cell Biology, Department of Oncology Propaedeutics, Medical University of Warsaw, 01-445 Warsaw, Poland
| | - Marta Fudalej
- Department of Oncology Propaedeutics, Medical University of Warsaw, 01-445 Warsaw, Poland
| | - Michał Budzik
- Department of Oncology Propaedeutics, Medical University of Warsaw, 01-445 Warsaw, Poland
| | | | - Andrzej Deptała
- Department of Oncology Propaedeutics, Medical University of Warsaw, 01-445 Warsaw, Poland
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Hata T, Mizuma M, Kusakabe T, Amano H, Furukawa T, Iwao T, Unno M. Simultaneous and sequential combination of genetic and epigenetic biomarkers for the presence of high-grade dysplasia in patients with pancreatic cyst: Discovery in cyst fluid and test in pancreatic juice. Pancreatology 2023; 23:218-226. [PMID: 36707261 DOI: 10.1016/j.pan.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND/OBJECTIVES Screening patients with intraductal papillary mucinous neoplasms (IPMN) has the primary goal of identifying potentially curable noninvasive precursors. We aimed to evaluate the diagnostic impact of genetic and epigenetic biomarkers in the presence of noninvasive precursors. METHODS Mutated KRAS/GNAS and methylated SOX17/TBX15/BMP3/TFPI2 DNA were assessed by droplet digital PCR in a discovery cohort of 70 surgically aspirated cyst fluids, and diagnostic performances for differentiating high-grade dysplasia (HGD) from low-grade dysplasia (LGD) was evaluated. We then tested these markers using an independent test cohort consisting of 156 serially collected pancreatic juice samples from 30 patients with IPMN. RESULTS Mutated KRAS and GNAS are specific for IPMNs but are not helpful for the prediction of histological grades. Cyst fluids from IPMN with HGD showed higher methylation levels of SOX17 (median, 0.141 vs. 0.021; P = 0.086) and TBX15 (median, 0.030 vs. 0.003; P = 0.028) than those with LGD. The combination of all tested markers yielded a diagnostic performance with sensitivity of 69.6%, and specificity of 90.0%. Among the 30 pancreatic juice samples exhibiting the highest abundance of KRAS/GNAS mutations in each patient in the test cohort, patients with histologically proven HGD due to pancreatic resection had a significantly higher prevalence (100% vs. 31%, P = 0.018) and abundance (P = 0.037) of methylated TBX15 than those without cytohistological diagnosis undergoing surveillance. CONCLUSIONS A simultaneous and sequential combination of mutated and methylated DNA markers in pancreatic cyst fluid and juice sample markers can help detect noninvasive pancreatic precursor neoplasms.
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Affiliation(s)
- Tatsuo Hata
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Surgery, Aidu Chuo Hospital, Aizuwakamatsu, Japan.
| | - Masamichi Mizuma
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Kusakabe
- Department of Pathology, Aidu Chuo Hospital, Aizuwakamatsu, Japan
| | - Hodaka Amano
- Department of Surgery, Aidu Chuo Hospital, Aizuwakamatsu, Japan
| | - Toru Furukawa
- Department of Investigative Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toshiyasu Iwao
- Department of Gastroenterology, Aidu Chuo Hospital, Aizuwakamatsu, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Revoredo Rego F, Reaño Paredes G, de Vinatea de Cárdenas J, Herrera Chávez G, Kometter Barrios F, Arenas Gamio J. Neoplasia mucinosa papilar intraductal del páncreas: características clínico-patológicas y supervivencia a largo plazo de pacientes sometidos a pancreatectomía. Cir Esp 2023. [DOI: 10.1016/j.ciresp.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Comparison of Clinical and Imaginal Features According to the Pathological Grades of Dysplasia in Branch-Duct Intraductal Papillary Mucinous Neoplasm (BD-IPMN) for Personalized Medicine. J Pers Med 2023; 13:jpm13010149. [PMID: 36675810 PMCID: PMC9863534 DOI: 10.3390/jpm13010149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/31/2022] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
Background: In patients with BD-IPMN, surgical indications have been focused on finding malignant lesions (HGD, high-grade dysplasia/IC, invasive carcinoma). The aim of this study was to compare the preoperative factors that distinguish HGD from LGD (low-grade dysplasia) and HGD from IC to find the optimal pathologic target for surgery according to individuals, considering surgical risks and outcomes. Methods: We retrospectively analyzed 232 patients with BD-IPMN diagnosed based on pathology after surgery and preoperative images. The primary outcome was identifying preoperative factors distinguishing HGD from LGD, and HGD from IC. Results: In patients with LGD/HGD, a solid component or an enhancing mural nodule ≥ 5 mm (OR = 9.29; 95% CI: 3.3−54.12; p < 0.000) and thickened/enhancing cyst walls (OR = 6.95; 95% CI: 1.68−33.13; p = 0.008) were associated with HGD. In patients with malignant lesions (HGD/IC), increased serum CA 19-9 (OR = 12.59; 95% CI: 1.81−87.44; p = 0.006) was associated with IC. Conclusions: The predictive factors for HGD were the presence of a solid component or an enhancing mural nodule ≥ 5 mm and thickened/enhancing cyst walls compared with LGD, and if accompanied by increased CA 19-9, it might be necessary to urgently evaluate the lesion due to the possibility of progression to IC. Based on this finding, we need to find HGD as the optimal pathologic target for surgery to improve survival in low-surgical-risk patients, and IC could be assumed to be the optimal pathologic target for surgery in high-surgical-risk patients because of high morbidity and mortality associated with surgery.
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Risk Assessment and Pancreatic Cancer: Diagnostic Management and Artificial Intelligence. Cancers (Basel) 2023; 15:cancers15020351. [PMID: 36672301 PMCID: PMC9857317 DOI: 10.3390/cancers15020351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
Pancreatic cancer (PC) is one of the deadliest cancers, and it is responsible for a number of deaths almost equal to its incidence. The high mortality rate is correlated with several explanations; the main one is the late disease stage at which the majority of patients are diagnosed. Since surgical resection has been recognised as the only curative treatment, a PC diagnosis at the initial stage is believed the main tool to improve survival. Therefore, patient stratification according to familial and genetic risk and the creation of screening protocol by using minimally invasive diagnostic tools would be appropriate. Pancreatic cystic neoplasms (PCNs) are subsets of lesions which deserve special management to avoid overtreatment. The current PC screening programs are based on the annual employment of magnetic resonance imaging with cholangiopancreatography sequences (MR/MRCP) and/or endoscopic ultrasonography (EUS). For patients unfit for MRI, computed tomography (CT) could be proposed, although CT results in lower detection rates, compared to MRI, for small lesions. The actual major limit is the incapacity to detect and characterize the pancreatic intraepithelial neoplasia (PanIN) by EUS and MR/MRCP. The possibility of utilizing artificial intelligence models to evaluate higher-risk patients could favour the diagnosis of these entities, although more data are needed to support the real utility of these applications in the field of screening. For these motives, it would be appropriate to realize screening programs in research settings.
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15
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Koike D, Kato H, Asano Y, Ito M, Arakawa S, Kawabe N, Shimura M, Hayashi C, Ochi T, Kamio K, Kawai T, Yasuoka H, Higashiguchi T, Horiguchi A. Natural history of intracholecystic papillary neoplasm (ICPN): a rare case of ICPN whose natural history was closely followed by ultrasound. BMC Gastroenterol 2022; 22:377. [PMID: 35941538 PMCID: PMC9358872 DOI: 10.1186/s12876-022-02454-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 07/27/2022] [Indexed: 11/24/2022] Open
Abstract
The natural history of intracholecystic papillary neoplasm (ICPN), especially the speed of growth from small benign to a carcinomatous lesion, is quite unrevealed. Here, we report an extremely rare case of ICPN, in which the papillary lesion was observed transforming from small and benign to malignant using abdominal ultrasound (AUS) over 2 years during routine health checks. A 44-year-old man underwent a routine health check-up. The initial AUS showed a small sessile polyp in the gallbladder, which enlarged slightly at the next AUS, a year later. In the third year, the polypoid lesion enlarged markedly, with a maximum diameter of 10 × 9 × 7 mm. Therefore, a laparoscopic cholecystectomy was performed. Microscopically, the 10 mm tumor had intracytoplasmic mucus, and a clear cytoplasm compatible with gastric-type features. Immunohistochemical analysis showed positive staining of atypical cells for MUC6 and PAS. These findings led to the diagnosis of ICPN with high-grade intraepithelial neoplasia of the gastric type. In conclusion, sessile polyps with rapid growth might be a crucial finding in the early stage of ICPN.
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Affiliation(s)
- Daisuke Koike
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Bantane Hospital, 3-6-10 Otobashi Nakagawa Ward, Nagoya, Aichi, 454-8509, Japan
| | - Hiroyuki Kato
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Bantane Hospital, 3-6-10 Otobashi Nakagawa Ward, Nagoya, Aichi, 454-8509, Japan.
| | - Yukio Asano
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Bantane Hospital, 3-6-10 Otobashi Nakagawa Ward, Nagoya, Aichi, 454-8509, Japan
| | - Masahiro Ito
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Bantane Hospital, 3-6-10 Otobashi Nakagawa Ward, Nagoya, Aichi, 454-8509, Japan
| | - Satoshi Arakawa
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Bantane Hospital, 3-6-10 Otobashi Nakagawa Ward, Nagoya, Aichi, 454-8509, Japan
| | - Norihiko Kawabe
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Bantane Hospital, 3-6-10 Otobashi Nakagawa Ward, Nagoya, Aichi, 454-8509, Japan
| | - Masahiro Shimura
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Bantane Hospital, 3-6-10 Otobashi Nakagawa Ward, Nagoya, Aichi, 454-8509, Japan
| | - Chihiro Hayashi
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Bantane Hospital, 3-6-10 Otobashi Nakagawa Ward, Nagoya, Aichi, 454-8509, Japan
| | - Takayuki Ochi
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Bantane Hospital, 3-6-10 Otobashi Nakagawa Ward, Nagoya, Aichi, 454-8509, Japan
| | - Kenshiro Kamio
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Bantane Hospital, 3-6-10 Otobashi Nakagawa Ward, Nagoya, Aichi, 454-8509, Japan
| | - Toki Kawai
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Bantane Hospital, 3-6-10 Otobashi Nakagawa Ward, Nagoya, Aichi, 454-8509, Japan
| | - Hironobu Yasuoka
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Bantane Hospital, 3-6-10 Otobashi Nakagawa Ward, Nagoya, Aichi, 454-8509, Japan
| | - Takahiko Higashiguchi
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Bantane Hospital, 3-6-10 Otobashi Nakagawa Ward, Nagoya, Aichi, 454-8509, Japan
| | - Akihiko Horiguchi
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Bantane Hospital, 3-6-10 Otobashi Nakagawa Ward, Nagoya, Aichi, 454-8509, Japan
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Yang Z, Shi G. Comparison of clinicopathologic characteristics and survival outcomes between invasive IPMN and invasive MCN: A population-based analysis. Front Oncol 2022; 12:899761. [PMID: 35965523 PMCID: PMC9372276 DOI: 10.3389/fonc.2022.899761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundIntraductal papillary mucinous neoplasm (IPMN) and mucinous cystic neoplasm (MCN) are two main histological subtypes of pancreatic cystic neoplasms with rapidly increasing incidence recently. The natural histories, treatment patterns, and survival outcomes of invasive IPMN and invasive MCN have not been well explored.MethodsPatients with a diagnosis of invasive IPMN and invasive MCN in the SEER database from 2000 through 2018 were retrospectively identified. Multivariable Cox regression analysis was conducted to determine the independent risk factors associated with overall survival (OS). Subgroup analyses of survival outcomes for invasive IPMN and invasive MCN were conducted. The OS for invasive IPMN was compared between patients who underwent surgery alone and those who received surgery plus chemotherapy by propensity score matching (PSM).ResultsA total of 2,505 patients were included, of whom 2,300 were diagnosed with invasive IPMN and 205 were diagnosed with invasive MCN. Half of the invasive IPMN (48.4%) and three-quarters of the invasive MCN (76.1%) patients were female. Of all patients, both the OS and cancer-specific survival were significantly better in the invasive MCN cohort compared to the invasive IPMN cohort. In subgroup analyses, while invasive MCN experienced better OS compared to invasive IPMN in the subgroups of patients with local–regional disease, the survival advantages disappeared in patients at a distant stage. In addition, surgery plus chemotherapy in invasive IPMN patients was associated with significantly better survival compared to surgery alone after PSM.ConclusionWe examined the demographic and clinical characteristics between invasive IPMN and invasive MCN patients using a large-population-based analysis. Although the OS is significantly better for invasive MCN versus invasive IPMN, the difference disappeared in patients with distant disease. A combination of surgery and chemotherapy in selected invasive IPMN patients could confer survival benefits compared to surgery alone.
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Brindl N, Boekhoff H, Bauer AS, Gaida MM, Dang HT, Kaiser J, Hoheisel JD, Felix K. Use of Autoreactive Antibodies in Blood of Patients with Pancreatic Intraductal Papillary Mucinous Neoplasms (IPMN) for Grade Distinction and Detection of Malignancy. Cancers (Basel) 2022; 14:cancers14153562. [PMID: 35892825 PMCID: PMC9332220 DOI: 10.3390/cancers14153562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/17/2022] [Accepted: 07/20/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: A reliable non-invasive distinction between low- and high-risk pancreatic intraductal papillary mucinous neoplasms (IPMN) is needed to effectively detect IPMN with malignant potential. This would improve preventative care and reduce the risk of developing pancreatic cancer and overtreatment. The present study aimed at exploring the presence of autoreactive antibodies in the blood of patients with IPMN of various grades of dysplasia. (2) Methods: A single-center cohort was studied composed of 378 serum samples from patients with low-grade IPMN (n = 91), high-grade IPMN (n = 66), IPMN with associated invasive cancer (n = 30), pancreatic ductal adenocarcinoma (PDAC) stages T1 (n = 24) and T2 (n = 113), and healthy controls (n = 54). A 249 full-length recombinant human protein microarray was used for profiling the serum samples. (3) Results: 14 proteins were identified as potential biomarkers for grade distinction in IPMN, yielding high specificity but mediocre sensitivity. (4) Conclusions: The identified autoantibodies are potential biomarkers that may assist in the detection of malignancy in IPMN patients.
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Affiliation(s)
- Niall Brindl
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- Division of Functional Genome Analysis, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (H.B.); (A.S.B.); (J.D.H.)
- Correspondence: (N.B.); (K.F.); Tel.: +49-163-638-1860 (N.B.)
| | - Henning Boekhoff
- Division of Functional Genome Analysis, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (H.B.); (A.S.B.); (J.D.H.)
| | - Andrea S. Bauer
- Division of Functional Genome Analysis, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (H.B.); (A.S.B.); (J.D.H.)
| | - Matthias M. Gaida
- Institute of Pathology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany;
- Research Center for Immunotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
- TRON, Translational Oncology at the University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Hien T. Dang
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA 19144, USA;
| | - Jörg Kaiser
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany;
| | - Jörg D. Hoheisel
- Division of Functional Genome Analysis, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (H.B.); (A.S.B.); (J.D.H.)
| | - Klaus Felix
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- Correspondence: (N.B.); (K.F.); Tel.: +49-163-638-1860 (N.B.)
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Utsunomiya T, Ogawa K, Funamizu N, Sakamoto K, Watanabe J, Otani H, Kawaguchi N, Miyagawa M, Iwaki H, Takada Y. The tumor‐to‐liver ratio of the standardized uptake value is a useful FDG‐PET/CT parameter for predicting malignant intraductal papillary mucinous neoplasm of the pancreas. Ann Gastroenterol Surg 2022; 6:695-703. [PMID: 36091311 PMCID: PMC9444866 DOI: 10.1002/ags3.12562] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/06/2022] [Accepted: 02/23/2022] [Indexed: 11/22/2022] Open
Abstract
Background The present study aimed to investigate the efficacy of positron emission tomography with 18Fluoro‐deoxyglucose (FDG‐PET/CT) for predicting malignant intraductal papillary mucinous neoplasm (IPMN). Methods The records of 88 patients pathologically diagnosed with IPMN after surgery at Ehime University Hospital and Ehime Prefectural Central Hospital from April 2009 to December 2020 were retrospectively reviewed. The patients’ characteristics, blood chemistry, and imaging examinations were evaluated as potential predictors of malignant IPMN. Of the PET/CT results, the maximum standardized uptake value (SUVmax) of the tumor, the tumor‐to‐blood pool ratio of the SUV (TBR), and the tumor‐to‐liver ratio of the SUV (TLR) were compared. Results On pathology, the diagnosis was adenoma (IPMA) in 40 patients, high‐grade dysplasia (HGD) in 26 patients, and carcinoma (IPMC) in 22 patients. HGD and IPMC were defined as malignant IPMN. On multivariate analyses, TLR ≥ 1.3 and high‐risk stigmata were independent predictors of malignant IPMN (P = .001 and P = .007, respectively). When both HRS and TLR ≥ 1.3 were present, the positive predictive value for malignancy was 88.2%. Furthermore, TLR was significantly higher for patients with IPMC than with HGD (P = .039). Conclusion TLR can be a useful predictor for differentiating benign from malignant IPMN and may be associated with postoperative outcomes.
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Affiliation(s)
- Takeshi Utsunomiya
- Department of Hepato‐Billiary‐Pancreatic Surgery Ehime University Hospital Ehime Japan
| | - Kohei Ogawa
- Department of Hepato‐Billiary‐Pancreatic Surgery Ehime University Hospital Ehime Japan
| | - Naotake Funamizu
- Department of Hepato‐Billiary‐Pancreatic Surgery Ehime University Hospital Ehime Japan
| | - Katsunori Sakamoto
- Department of Hepato‐Billiary‐Pancreatic Surgery Ehime University Hospital Ehime Japan
| | - Jota Watanabe
- Department of Gastroenterological Surgery Ehime Prefectural Central Hospital Ehime Japan
| | - Hiromi Otani
- Department of Gastroenterological Surgery Ehime Prefectural Central Hospital Ehime Japan
| | - Naoto Kawaguchi
- Department of Radiology Ehime University Graduate School of Medicine Ehime Japan
| | - Masao Miyagawa
- Department of Radiology Ehime University Graduate School of Medicine Ehime Japan
| | - Hirotaka Iwaki
- Department of Clinical Pharmacology and Therapeutics Ehime University Graduate School of Medicine Ehime Japan
| | - Yasutsugu Takada
- Department of Hepato‐Billiary‐Pancreatic Surgery Ehime University Hospital Ehime Japan
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Flor-de-Lima B, S․ Freitas P, Couto N, Castillo-Martin M, Santiago I. Pancreatic intraductal papillary mucinous neoplasm associated colloid carcinoma. Radiol Case Rep 2021; 16:2989-2992. [PMID: 34401039 PMCID: PMC8353403 DOI: 10.1016/j.radcr.2021.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/07/2021] [Accepted: 07/10/2021] [Indexed: 11/24/2022] Open
Abstract
Colloid carcinomas are rare pancreatic tumors characterized by the presence of mucin pools with scarce malignant cells. Most of these neoplasms arise from intestinal-type intraductal papillary mucinous neoplasms (IPMNs). We report a case of a 77-year-old male patient who presented with weight loss, asthenia, lumbar pain and diabetes. Imaging studies revealed a mixed-type IPMN with high-risk features and a possible invasive component. The patient underwent surgical resection and the histology confirmed an invasive colloid carcinoma of the pancreas associated with an intestinal-type IPMN. Although invasive ductal and colloid carcinomas may look similar on imaging studies, its distinction is important because the latter have a better prognosis.
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Affiliation(s)
- Beatriz Flor-de-Lima
- Radiology Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Patrícia S․ Freitas
- Department of Radiology, Centro Hospitalar Universitário de Lisboa Central, Alameda Santo António dos Capuchos, 1169-050 Lisbon, Portugal
| | - Nuno Couto
- Digestive Unit, Champalimaud Foundation, Av. Brasília, 1400-038 Lisbon, Portugal
| | - Mireia Castillo-Martin
- Department of Pathology, Champalimaud Foundation, Av. Brasília, 1400-038 Lisbon, Portugal
| | - Inês Santiago
- Department of Radiology, Champalimaud Foundation, Av. Brasília, 1400-038 Lisbon, Portugal
- Faculdade de Ciências Médicas - Nova Medical School, Campo dos Mártires da Pátria 130, 1169-056 Lisbon, Portugal
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Tonini V, Zanni M. Pancreatic cancer in 2021: What you need to know to win. World J Gastroenterol 2021; 27:5851-5889. [PMID: 34629806 PMCID: PMC8475010 DOI: 10.3748/wjg.v27.i35.5851] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 07/14/2021] [Accepted: 08/23/2021] [Indexed: 02/06/2023] Open
Abstract
Pancreatic cancer is one of the solid tumors with the worst prognosis. Five-year survival rate is less than 10%. Surgical resection is the only potentially curative treatment, but the tumor is often diagnosed at an advanced stage of the disease and surgery could be performed in a very limited number of patients. Moreover, surgery is still associated with high post-operative morbidity, while other therapies still offer very disappointing results. This article reviews every aspect of pancreatic cancer, focusing on the elements that can improve prognosis. It was written with the aim of describing everything you need to know in 2021 in order to face this difficult challenge.
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Affiliation(s)
- Valeria Tonini
- Department of Medical Sciences and Surgery, University of Bologna- Emergency Surgery Unit, IRCCS Sant’Orsola Hospital, Bologna 40121, Italy
| | - Manuel Zanni
- University of Bologna, Emergency Surgery Unit, IRCCS Sant'Orsola Hospital, Bologna 40121, Italy
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21
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Suzuki S, Shimoda M, Shimazaki J, Oshiro Y, Nishda K, Orimoto N, Nagakawa Y, Tsuchida A. Carbohydrate Antigen 19-9 Is an Invasive Malignancy Preoperative Prognostic Factor for Intraductal Papillary Mucinous Neoplasms. Eur Surg Res 2021; 62:262-270. [PMID: 34344012 DOI: 10.1159/000517558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 05/31/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study aimed to determine the preoperative clinicophysiological and postoperative clinicopathological predictors of malignancy in patients with intraductal papillary mucinous neoplasm (IPMN). METHODS This was a retrospective observational study. We included 121 patients (73 men and 48 women; mean age: 68.7 years) who had undergone pancreatic resection for IPMN between 2007 and 2018. These patients were grouped into invasive carcinoma (IPMN-INV, N = 21) and low/high-grade IPMN (IPMN-LG/HG, N = 100) groups. Univariate and multivariate analyses of clinicophysiological parameters were carried out. These parameters were also compared between the IPMN-INV/HG (N = 53) and IPMN-LG (N = 68) groups. Survival analyses according to macroscopic type and IPMN subtypes were performed. RESULTS On univariate analysis, age (p = 0.038), carbohydrate antigen (CA) 19-9 (p < 0.001), IPMN macroscopic type (p = 0.001), IPMN subtype (p < 0.001), pancreatic duct diameter (p < 0.001), and mural nodule (p = 0.042), between IPMN-INV and IPMN-LG/HG were found to be significant prognostic factors of malignancy. CA 19-9 was found to be an independent prognostic factor of IPMN malignancy on multivariate analysis (p = 0.035). The 1-, 3-, and 5-year overall survival (OS) rates of the IPMN-INV and IPMN-LG/HG groups were 94.4/100%, 94.4/100%, and 67.2/100%, respectively. The OS rate in the IPMN-LG/HG group was significantly higher than that in the IPMN-INV group (p < 0.001). On univariate analysis, platelet (p = 0.043), CA 19-9 (p = 0.039), prognostic nutritional index (p = 0.034), platelet/lymphocyte ratio (p = 0.01), IPMN macroscopic type (p < 0.001), IPMN subtype (p < 0.001), pancreatic duct diameter (p = 0.036), and mural nodule (p = 0.032) between IPMN-INV/HG and IPMN-LG were found to be significant prognostic factors of malignancy. On multivariate analysis, CA 19-9 was found to be an independent prognostic factor (p = 0.042) between IPMN-INV/HG and IPMN-LG of malignancy. The 1-, 3-, and 5-year OS rates of the IPMN-INV/HG and IPMN-LG groups were 97.9/100%, 97.9/100%, and 82.6/100%, respectively. The OS rate was significantly higher in the IPMN-LG group than in the IPMN-INV/HG group (p = 0.03). No significant differences in survival were observed in patients with macroscopic tumors (p= 0.544). CONCLUSION CA 19-9 is an independent invasive malignancy predictor of IPMN.
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Affiliation(s)
- Shuji Suzuki
- Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University, Ibaraki, Japan
| | - Mitsugi Shimoda
- Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University, Ibaraki, Japan
| | - Jiro Shimazaki
- Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University, Ibaraki, Japan
| | - Yukio Oshiro
- Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University, Ibaraki, Japan
| | - Kiyotaka Nishda
- Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University, Ibaraki, Japan
| | - Naoki Orimoto
- Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University, Ibaraki, Japan
| | - Yuichi Nagakawa
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Akihiko Tsuchida
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
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Choi M, Chong JU, Hwang HK, Seo HI, Yang K, Ryu JH, Roh Y, Kim DH, Lee JH, Lee WJ, Choi SH, Kang CM. Role of postoperative adjuvant therapy in resected invasive intraductal papillary mucinous neoplasm of the pancreas: A multicenter external validation. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 28:671-679. [PMID: 34028187 DOI: 10.1002/jhbp.996] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/04/2021] [Accepted: 04/12/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Adjuvant therapy is beneficial in prolonging survival in patients with pancreatic ductal adenocarcinoma (PDAC). However, no clear guidelines are available on the oncologic effect of adjuvant therapy in resected invasive intraductal papillary mucinous neoplasms (inv-IPMN). METHODS In total, 551 patients with PDAC and 67 patients with inv-IPMN of the pancreas were reviewed. For external validation, 46 patients with inv-IPMN from six other Korean institutions were enrolled. Propensity score-matched analysis and stage-matched survival analysis were conducted. RESULTS The mean follow-up durations in the inv-IPMN and PDAC groups were 43.36 months (SD, 42.34 months) and 43.35 months (SD, 35.62 months), respectively. The 5-year overall survival (OS) was significantly better in the resected inv-IPMN group than in the PDAC group in the overall stage-matched analysis (P < .001). In the inv-IPMN cohort, OS was better in the surgery alone group (P = .042). In subgroup analysis, no significant survival difference was found between the adjuvant therapy and surgery alone groups according to the stage (stage I; P = .285, stage II or III; P = .077). Multicenter external validation did not show a better OS in the adjuvant therapy group (P = .531). On multivariable analysis, only perineural invasion (PNI) was identified as an adverse prognostic factor in resected inv-IPMN (HR 4.844; 95% CI 1.696-13.838, P = .003). CONCLUSIONS inv-IPMN has a more indolent course than PDAC. Current strategy of adjuvant therapy may not improve the OS in patients with resected inv-IPMN. Further investigations on the potential role of adjuvant therapy in inv-IPMN are mandatory.
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Affiliation(s)
- Munseok Choi
- Department of Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Korea
| | - Jae Uk Chong
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Ho Kyoung Hwang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung-Il Seo
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Kwangho Yang
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Je Ho Ryu
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Younghoon Roh
- Department of Surgery, Dong-A University Medical Center, Dong-A University College of Medicine, Busan, Korea
| | - Dong Hyun Kim
- Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jin Ho Lee
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Woo Jung Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Hoon Choi
- Division of Hepatobiliary and Pancreas, Department of Surgery, CHA Bundang Medical Center, CHA University, Seongam-si, Korea
| | - Chang Moo Kang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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A narrative review on endopancreatic interventions: an innovative access to the pancreas. JOURNAL OF PANCREATOLOGY 2021. [DOI: 10.1097/jp9.0000000000000069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Prognostic impact of conservative surgery for pancreatic IPMNs. Surg Oncol 2021; 38:101582. [PMID: 33892432 DOI: 10.1016/j.suronc.2021.101582] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 04/10/2021] [Accepted: 04/11/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The extent of pancreatic resection for intraductal papillary mucinous neoplasms (IPMNs) remains an unresolved issue. The study aims at analyzing the prognostic impact of conservative surgery (CS) i.e. of pancreatoduodenectomy or distal pancreatectomy, versus total pancreatectomy (TP), for pancreatic IPMNs. METHODS We retrospectively analyzed and compared data of patients who had undergone pancreatic resection for IPMNs at our center between November 2007 and April 2019. Patients were divided into two main groups based on the extent of surgery: TP-group and CS-group. Subsequently, the perioperative and the long-term outcomes were compared. Moreover, a sub-group analysis of patients with IPMN alone and patients with malignant IPMN, based on preoperative indications to surgery and post-operative histopathological findings, was also performed. RESULTS Fifty-three patients were included in the TP-group and 73 in the CS-group. In 50 (39.7%) cases the frozen section changed the pre-operative surgical planning, with an extension of the pancreatic resection, in 43 (34.1%) cases up to a total pancreatectomy. Twenty-six patients (20.6%) with low-grade dysplasia at the frozen section underwent CS, while twenty (15.8%) underwent TP. Comparing these two sub-groups no differences were found in surgical IPMN recurrence, nor progression. The rate of overall postoperative complications was 56.6% in the TP-group and 57.5% in the CS-group (p = 0.940). Fifteen patients (20.5%) developed diabetes in the CS-group. None of the patients treated with CS developed a surgical IPMN recurrence or progression during the follow-up period. Comparing OS and DFS of the two groups, we did not find any statistically significant difference (p = 0.619 and 0.315). CONCLUSION A timely CS can be considered an appropriate and valid strategy in the surgical treatment of the majority of pancreatic IPMNs, as it can avoid the serious long-term metabolic consequences of TP in patients with a long-life expectancy. On the contrary, TP remains mandatory in case of PDAC or high-risk features involving the entire gland.
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25
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Udare A, Agarwal M, Alabousi M, McInnes M, Rubino JG, Marcaccio M, van der Pol CB. Diagnostic Accuracy of MRI for Differentiation of Benign and Malignant Pancreatic Cystic Lesions Compared to CT and Endoscopic Ultrasound: Systematic Review and Meta-analysis. J Magn Reson Imaging 2021; 54:1126-1137. [PMID: 33847435 DOI: 10.1002/jmri.27606] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Differentiation of benign and malignant pancreatic cystic lesions on MRI, computed tomography (CT), and endoscopic ultrasound (EUS) is critical for determining management. PURPOSE To perform a systematic review evaluating the diagnostic accuracy of MRI for diagnosing malignant pancreatic cystic lesions, and to compare the accuracy of MRI to CT and EUS. STUDY TYPE Systematic review and meta-analysis. DATA SOURCES MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus were searched until February 2020 for studies reporting MRI accuracy for assessing pancreatic cystic lesions. FIELD STRENGTH 1.5T or 3.0T. ASSESSMENT Methodologic and outcome data were extracted by two reviewers (AU and MA, 2 years of experience each). All studies of pancreatic cystic lesions on MRI were identified. Studies with incomplete MRI technique were excluded. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool. STATISTICAL TESTS Sensitivity/specificity was pooled using bivariate random-effects meta-analysis with 95% confidence intervals (95%CI). Pairwise-comparison of MRI to CT and EUS was performed. The impact of gadolinium-based contrast agents, mucinous lesions, and risk of bias were explored using meta-regression. RESULTS MRI pooled sensitivity was 76% (95%CI 67% to 84%) and specificity was 80% (95%CI 74% to 85%) for distinguishing benign and malignant lesions. MRI and CT had similar sensitivity (P = 0.822) and specificity (P = 0.096), but MRI was more specific than EUS (80% vs. 75%, P < 0.05). Studies including only contrast-enhanced MRI were more sensitive than those including unenhanced exams (P < 0.05). MRI sensitivity and specificity did not differ for mucinous lesions (P = 0.537 and P = 0.384, respectively) or for studies at risk of bias (P = 0.789 and P = 0.791, respectively). DATA CONCLUSION MRI and CT demonstrate comparable accuracy for diagnosing malignant pancreatic cystic lesions. EUS is less specific than MRI, which suggests that, in some cases, management should be guided by MRI findings rather than EUS. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Amar Udare
- Department of Diagnostic Imaging, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Minu Agarwal
- Department of Diagnostic Imaging, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Mostafa Alabousi
- Department of Diagnostic Imaging, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Matthew McInnes
- Department of Radiology and Epidemiology, Ottawa Hospital Research Institute Clinical Epidemiology Program, University of Ottawa, Ottawa, Ontario, Canada
| | - Julian G Rubino
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Michael Marcaccio
- Department of Surgery, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Christian B van der Pol
- Department of Diagnostic Imaging, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Matsushita N, Douhara A, Ueno H, Asada S, Murata K, Yanase K, Tsutsumi M. Intraductal papillary-mucinous carcinoma with portal vein tumor thrombus and multifocal liver metastasis: An autopsy case. Mol Clin Oncol 2021; 14:101. [PMID: 33815792 PMCID: PMC8015015 DOI: 10.3892/mco.2021.2263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 02/05/2021] [Indexed: 12/18/2022] Open
Abstract
The prognosis of intraductal papillary-mucinous neoplasm is superior to that of conventional pancreatic ductal adenocarcinoma. Only a few advanced cases of intraductal papillary-mucinous carcinoma (IPMC) have been reported to date. We herein report the case of a 78-year-old male patient with advanced pancreatobiliary type IPMC with portal vein invasion and liver metastasis. The IPMC invaded the portal vein to form a tumor thrombus and it also metastasized to the liver via the portal vein. After receiving best supportive care, the patient succumbed to the disease following an exacerbation of IPMC 90 days after the initial presentation. On autopsy, a very long tumor thrombus was identified, along with liver metastatic lesions, which had retained the structure of the primary IPMC on histological examination.
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Affiliation(s)
- Naohiro Matsushita
- Clinical Study and Training Center, Saiseikai Chuwa Hospital, Sakurai, Nara 633-0054, Japan
| | - Akitoshi Douhara
- Department of Gastroenterology, Saiseikai Chuwa Hospital, Sakurai, Nara 633-0054, Japan
| | - Hirotsugu Ueno
- Department of Gastroenterology, Saiseikai Chuwa Hospital, Sakurai, Nara 633-0054, Japan
| | - Shohei Asada
- Department of Gastroenterology, Saiseikai Chuwa Hospital, Sakurai, Nara 633-0054, Japan
| | - Koji Murata
- Department of Gastroenterology, Saiseikai Chuwa Hospital, Sakurai, Nara 633-0054, Japan
| | - Koji Yanase
- Department of Gastroenterology, Saiseikai Chuwa Hospital, Sakurai, Nara 633-0054, Japan
| | - Masahiro Tsutsumi
- Department of Pathology, Saiseikai Chuwa Hospital, Sakurai, Nara 633-0054, Japan
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Tang CT, Liu BX, Chen Y, Zeng C. Analyzing and predicting the LNM rate and prognosis of patients with intraductal papillary mucinous neoplasm of the pancreas. Cancer Med 2021; 10:1925-1935. [PMID: 33641255 PMCID: PMC7957210 DOI: 10.1002/cam4.3632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 10/22/2020] [Accepted: 11/14/2020] [Indexed: 11/07/2022] Open
Abstract
Background Current the surveillance and management are controversial for patients with IPMN. We aimed to develop an alternative nomogram to individualize IPMN prognosis and LNM. Methods Based on the data from SEER database of patients diagnosed with IPMN between 2004 and 2015, a nomogram predicting the survival and LNM of IPMN based on univariate and multivariate and Lasso regression analysis was performed, internally and externally validated, and measured by C‐index, and decision curve analysis (DCA), and compared to the 7th TNM stage. Results A total of 941 patients were included. Age, T stage examined nodes, tumor size, and pathology grade were identified as an independent factor for predicting LNM. The nomogram we established to predict LNM had a high predicting value with a C‐index value of 0.735 and an AUC value of 0.753. Interestingly, including T1 stage, we found an inverse correlation was between age and LNM. In addition, nomogram for predicting CSS also performed better than TNM stage both in the internal validation group (1‐year AUC:0.753 vs. 0.693, 3‐year AUC: 0.801 vs. 0.731, 5‐year AUC: 0.803 vs. 0.733) and external validation group (1‐year AUC: 0.761 vs. 0.701, 3‐year AUC: 0.772 vs. 0.713, 5‐year AUC:0.811 vs. 0.735). DCA analysis showed the nomogram showed a greater benefit across the period of follow‐up compared to 7th TNM stage. Conclusion A nomogram based on multivariate and Lasso regression analysis showed great clinical usability compared with current criteria. Also, for LNM of IPMN, younger age patients with IPMN should be attached more importance.
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Affiliation(s)
- Chao-Tao Tang
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Bi-Xia Liu
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Youxiang Chen
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Chunyan Zeng
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang, China
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28
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Djordjevic V, Grubor N, Kovac JD, Micev M, Milic N, Knezevic D, Gregoric P, Lausevic Z, Kerkez M, Knezevic S, Radenkovic D. Comparison of Preoperative Evaluation with the Pathological Report in Intraductal Papillary Mucinous Neoplasms: A Single-Center Experience. J Clin Med 2021; 10:678. [PMID: 33578680 PMCID: PMC7916322 DOI: 10.3390/jcm10040678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/05/2021] [Accepted: 02/07/2021] [Indexed: 12/17/2022] Open
Abstract
The key to the successful management of pancreatic cystic neoplasm (PCN), among which intraductal papillary mucinous neoplasm (IPMN) is the one with the highest risk of advanced neoplasia in resected patients, is a careful combination of clinical, radiological, and histopathological findings. This study aims to perform the comparison of a preoperative evaluation with pathological reports in IPMN and further, to evaluate and compare the diagnostic performance of European evidence-based guidelines on pancreatic cystic neoplasms (EEBGPCN) and Fukuoka Consensus guidelines (FCG). We analyzed 106 consecutive patients diagnosed with different types of PCN, among whom 68 had IPMN diagnosis, at the Clinical Center of Serbia. All the patients diagnosed with IPMNs were stratified concerning the presence of the absolute and relative indications according to EEBGPCN and high-risk stigmata and worrisome features according to FCG. Final histopathology revealed that IPMNs patients were further divided into malignant (50 patients) and benign (18 patients) groups, according to the pathological findings. The preoperative prediction of malignancy according to EEBGPCN criteria was higher than 70% with high sensitivity of at least one absolute or relative indication for resection. The diagnostic performance of FCG was shown as comparable to EEBGPCN. Nevertheless, the value of false-positive rate for surgical resection showed that in some cases, overtreating patients or treating them too early cannot be prevented. A multidisciplinary approach is essential to adequately select patients for the resection considering at the same time both the risks of surgery and malignancy.
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Affiliation(s)
- Vladimir Djordjevic
- Clinic for Digestive Surgery, First Surgical Clinic, Clinical Centre of Serbia, 11000 Belgrade, Serbia; (N.G.); (D.K.); (M.K.); (S.K.); (D.R.)
| | - Nikica Grubor
- Clinic for Digestive Surgery, First Surgical Clinic, Clinical Centre of Serbia, 11000 Belgrade, Serbia; (N.G.); (D.K.); (M.K.); (S.K.); (D.R.)
- Department for Surgery, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (P.G.); (Z.L.)
| | - Jelena Djokic Kovac
- Centre for Radiology and Magnetic Resonance Imaging, Clinical Centre of Serbia, 11000 Belgrade, Serbia;
- Department for Radiology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Marjan Micev
- Department of Histopathology, Clinical Centre of Serbia, 11000 Belgrade, Serbia;
| | - Natasa Milic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; or
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, NY 55905, USA
| | - Djordje Knezevic
- Clinic for Digestive Surgery, First Surgical Clinic, Clinical Centre of Serbia, 11000 Belgrade, Serbia; (N.G.); (D.K.); (M.K.); (S.K.); (D.R.)
- Department for Surgery, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (P.G.); (Z.L.)
| | - Pavle Gregoric
- Department for Surgery, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (P.G.); (Z.L.)
- Centre for Emergency Surgery, Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Zeljko Lausevic
- Department for Surgery, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (P.G.); (Z.L.)
- Centre for Emergency Surgery, Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Mirko Kerkez
- Clinic for Digestive Surgery, First Surgical Clinic, Clinical Centre of Serbia, 11000 Belgrade, Serbia; (N.G.); (D.K.); (M.K.); (S.K.); (D.R.)
- Department for Surgery, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (P.G.); (Z.L.)
| | - Srbislav Knezevic
- Clinic for Digestive Surgery, First Surgical Clinic, Clinical Centre of Serbia, 11000 Belgrade, Serbia; (N.G.); (D.K.); (M.K.); (S.K.); (D.R.)
- Department for Surgery, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (P.G.); (Z.L.)
| | - Dejan Radenkovic
- Clinic for Digestive Surgery, First Surgical Clinic, Clinical Centre of Serbia, 11000 Belgrade, Serbia; (N.G.); (D.K.); (M.K.); (S.K.); (D.R.)
- Department for Surgery, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (P.G.); (Z.L.)
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Zhang XP, Xu S, Wang Y, Wang ZZ, Tan XL, Gao YX, Zhao GD, Liu Q, Zhao ZM, Liu R. Robotic pancreatectomy for intraductal papillary mucinous neoplasm of the pancreas: A large-scale study. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 28:942-952. [PMID: 33174361 DOI: 10.1002/jhbp.864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/11/2020] [Accepted: 10/17/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a mucin-producing tumor that develops from the epithelial lining of the main pancreatic duct or branch pancreatic ducts. Here, we assessed the feasibility and safety of various robotic pancreatectomy approaches to treating IPMN, and short- and long-term outcomes of robotic IPMN resection. METHODS Data from patients who underwent robotic pancreatectomy for IPMN between 2012 and 2019 at our hospital were retrospectively analyzed. The survival outcomes for patients were compared using the Kaplan-Meier method and Cox regression analysis. RESULTS Of the 174 patients who underwent robotic pancreatectomy, 120 and 54 patients had benign or malignant tumors, respectively. Patients with malignant IPMN had lost more weight in the 6 months prior to surgery (P = .008), and a higher serum level of CA19-9 (P < .001) and CEA (P < .001). Postoperative pancreatic or biliary fistula occurred in 17 or 6 patients overall, respectively. The pathology of the IPMN (P = .030), tumor diameter (P = .016), mural nodule (P = .023), tumor capsule (P = .003) and CA19-9 (P = .024) values were all independent risk factors for survival. The median OS time after surgical resection for the malignant IPMN group was 29.0 months (range, 21.6-36.4). The OS was significantly different in patients with IPMN according to their different pathology, tumor capsule, mural nodule group, CA19-9 level, or tumor diameter. CONCLUSIONS This large-scale survey of 174 patients indicated that various robotic pancreatectomy approaches were feasible and safe for IPMN. Patients had an acceptable prognosis, indicating that robotic pancreatectomy represents a feasible potential therapeutic strategy for IPMN.
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Affiliation(s)
- Xiu-Ping Zhang
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, Beijing, China
| | - Shuai Xu
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Yang Wang
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, Beijing, China
| | - Zi-Zheng Wang
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, Beijing, China
| | - Xiang-Long Tan
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, Beijing, China
| | - Yuan-Xing Gao
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, Beijing, China
| | - Guo-Dong Zhao
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, Beijing, China
| | - Qu Liu
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, Beijing, China
| | - Zhi-Ming Zhao
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, Beijing, China
| | - Rong Liu
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
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Hata T, Mizuma M, Motoi F, Omori Y, Ishida M, Nakagawa K, Hayashi H, Morikawa T, Kamei T, Furukawa T, Unno M. GNAS mutation detection in circulating cell-free DNA is a specific predictor for intraductal papillary mucinous neoplasms of the pancreas, especially for intestinal subtype. Sci Rep 2020; 10:17761. [PMID: 33082481 PMCID: PMC7576136 DOI: 10.1038/s41598-020-74868-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 09/17/2020] [Indexed: 02/07/2023] Open
Abstract
Pancreatic cystic neoplasms (PCNs) are a heterogeneous group with varying risks of malignancy. To explore the clinical utility of liquid biopsy in cyst type classification, we analyzed the GNAS/KRAS mutations in circulating cell-free DNA (cfDNA) obtained from 57 patients with histologically diagnosed PCNs, including 34 with intraductal papillary mucinous neoplasms (IPMNs) and compared the mutant allele prevalence and variant patterns with the paired resected specimens using next-generation sequencing. The positive prevalence of GNAS mutations in cfDNA of patients with IPMN (n = 11, 32%) was significantly higher than that in those with other PCNs (0%, P = 0.002). Conversely, KRAS mutations were detected in cfDNA of only 2 (6%) IPMN patients. The paired-sample comparison revealed highly concordance between the GNAS mutation status of cfDNA and resected IPMN specimens. Similar distributions of GNAS mutation positivity in cfDNA were observed across the different histological grades, whereas IPMNs with intestinal subtype showed a significantly higher prevalence of GNAS mutations than other subtypes (P = 0.030). GNAS mutation positivity in cfDNA was significantly associated with the acellular mucin pool of histological findings in primary IPMN lesions (P = 0.017). Detection of GNAS mutation in cfDNA can serve as a novel biomarker for cyst type classification and differentiation of intestinal subtype IPMN from the other PCNs.
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Affiliation(s)
- Tatsuo Hata
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
| | - Masamichi Mizuma
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Fuyuhiko Motoi
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Yuko Omori
- Department of Investigative Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masaharu Ishida
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Kei Nakagawa
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Hiroki Hayashi
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Takanori Morikawa
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Takashi Kamei
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Toru Furukawa
- Department of Investigative Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
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Bassaneze T, Laham AY, Gomes LGL, Coelho BQ, Martinez CAR. Mixed-type intraductal papillary mucinous neoplasm: Tailored surgical planning - case report. Int J Surg Case Rep 2020; 76:111-115. [PMID: 33022561 PMCID: PMC7548937 DOI: 10.1016/j.ijscr.2020.09.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION With the greater availability of imaging exams, the diagnosis of intraductal papillary mucinous neoplasms (IPMNs) has increased recently. However, there are still questions about adequate management approaches for this disease, especially regarding the best therapeutic strategy. The objective is to describe the case of a patient with mixed-type (MT) IPMN successfully treated by a tailored surgical plan that adopted duodenopancreatectomy and imaging to monitor the remaining lesions of the tail and body of the pancreas. PRESENTATION OF CASE A 65-year-old asymptomatic man underwent ultrasonography of the abdomen and was diagnosed with a cystic tumor, measuring 3.0 × 2.5 cm, located on the head of the pancreas. Magnetic resonance cholangiopancreatography (MRCP) showed dilation of the main pancreatic duct and multiple cystic lesions scattered throughout the entire parenchyma. The patient underwent duodenopancreatectomy; postoperatively, he did not have complications and was discharged on the 6th postoperative day. The histopathological panel confirmed the presence of MT-IPMN of the intestinal pattern. The patient is currently well four years after surgery and is undergoing semiannual MRCP examinations to follow up the remaining lesions. DISCUSSION MT-IPMNs represent 28-41% of all IPMNs. Among all subtypes, MT-IPMNs are the most challenging in terms of choosing the ideal therapeutic strategy. These lesions are the most difficult to treat because they can be multifocal and compromise different locations of the pancreatic parenchyma. CONCLUSION MRI findings, Ca19.9 serum level and negative family history of pancreatic neoplasia were indications for the surgical choice for the MT- IPMN presented in this case.
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Affiliation(s)
- Thiago Bassaneze
- Digestive Surgery Department, Hospital Brazil - Rede D'Or, Santo André, SP, Brazil.
| | | | | | - Bruna Queiroz Coelho
- Digestive Surgery Department, Faculty of Medicine of ABC Foundation, Santo André, SP, Brazil.
| | - Carlos Augusto Real Martinez
- Post Graduate Program in Health of Sciences, São Francisco University Medical School (USF), Bragança Paulista-SP, Brazil; Department of Surgery, University of Campinas, Campinas, SP, Brazil.
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Niiya F, Ohike N, Norose T, Takano Y, Azami T, Kobayashi T, Maruoka N, Wakabayashi T, Matsuo K, Tanaka K, Nagahama M. Can the location of the mural nodule indicate benign or malignant in branch duct-type intraductal papillary mucinous neoplasm of the pancreas? Pancreatology 2020; 20:1379-1385. [PMID: 32873485 DOI: 10.1016/j.pan.2020.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/09/2020] [Accepted: 08/11/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES Intraductal papillary mucinous neoplasms (IPMNs) are classified into main duct (MD)-type IPMNs, branch duct (BD)-type IPMNs, and mixed type IPMNs. While MD-type IPMN has a high risk of malignancy and should therefore be considered for resection if the patient is fit, BD-type IPMN needs to be carefully judged for surgical indication. The decision to resect BD-type IPMN is often based on international consensus Fukuoka guidelines 2017, but further investigation is required. In this study, we focused on whether the location of the mural nodule (MN) could be an indicator of malignancy. METHODS We enrolled 17 cases who had been diagnosed BD-type IPMNs which were surgically resected from January 2016 to December 2019. These cases were classified into benign and malignant group. Subsequently, a clinicopathological study was conducted based on the localization of MN (MN-central type or MN-peripheral type). RESULTS Although MN was found in 57% (4/11) in the benign group, 88% (7/8) was noted in the malignant group, indicating the presence of MN to be more common in the malignant group. Those with MN consisted of 6 cases of MN-central type and 5 cases of MN-peripheral type. All cases of central type were malignant compared to only one case of the peripheral group being confirmed on histology as cancer. CONCLUSION BD-IPMN with central mural nodule should be considered high risk for malignancy.
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Affiliation(s)
- Fumitaka Niiya
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan; Department of Pathology and Laboratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan.
| | - Nobuyuki Ohike
- Department of Pathology and Laboratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Tomoko Norose
- Department of Pathology and Laboratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Yuichi Takano
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Tetsushi Azami
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Takahiro Kobayashi
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Naotaka Maruoka
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Tetsuji Wakabayashi
- Department of General and Gastroenterological Surgery, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Kenichi Matsuo
- Department of General and Gastroenterological Surgery, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Kuniya Tanaka
- Department of General and Gastroenterological Surgery, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Masatsugu Nagahama
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
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Asano T, Nakamura T, Noji T, Okamura K, Tsuchikawa T, Ebihara Y, Nakanishi Y, Tanaka K, Matsui A, Shichinohe T, Hirano S. Outcomes of limited resection for patients with intraductal papillary mucinous neoplasm of the pancreas: A single-center experience. Pancreatology 2020; 20:1399-1405. [PMID: 32972836 DOI: 10.1016/j.pan.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/16/2020] [Accepted: 09/09/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND /ObjectivesThe aim of this study was to clarify the oncological outcomes of patients with intraductal papillary mucinous neoplasm (IPMN) who underwent limited resection (LR). METHODS This retrospective study analyzed the data of 110 patients with IPMN. Patients with IPMN without a history of pancreatitis who had neither tumor infiltration nor regional lymph node swelling on imaging findings underwent LR. We assessed the oncological outcomes of LR for patients with IPMN by comparing the surgical outcomes of LR and standard resection. RESULTS LR was performed in 50 patients (45.5%), including duodenum-preserving pancreatic head resection (n = 31), middle-pancreatectomy (n = 12), spleen-preserving distal pancreatectomy (n = 3), total parenchymal pancreatectomy (n = 3), and partial resection (n = 1). In the LR group, 18 patients had postoperative complications of Clavien-Dindo classification ≥ IIIa. After histopathological examination, the presence of high-grade dysplasia (HGD) and invasive carcinoma (IC) were observed in nine and three patients, respectively, in the LR group, and eight and 22 patients, respectively, in the standard resection group. There was a significant difference in the histopathological diagnosis of IC between the two groups (p < 0.001). Finally, in the LR group, postoperative recurrences occurred in three patients, and the 5-, 10-, and 15-year disease-specific survival rates were all 97.0%. CONCLUSIONS For patients with IPMN judged to have no infiltrating lesions based on the detailed imaging examination, LR is acceptable and may be considered as an alternative to standard resection.
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Affiliation(s)
- Toshimichi Asano
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, West-7, North-15, Kita-ku, Sapporo, 060-8638, Japan
| | - Toru Nakamura
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, West-7, North-15, Kita-ku, Sapporo, 060-8638, Japan.
| | - Takehiro Noji
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, West-7, North-15, Kita-ku, Sapporo, 060-8638, Japan
| | - Keisuke Okamura
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, West-7, North-15, Kita-ku, Sapporo, 060-8638, Japan
| | - Takahiro Tsuchikawa
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, West-7, North-15, Kita-ku, Sapporo, 060-8638, Japan
| | - Yuma Ebihara
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, West-7, North-15, Kita-ku, Sapporo, 060-8638, Japan
| | - Yoshitsugu Nakanishi
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, West-7, North-15, Kita-ku, Sapporo, 060-8638, Japan
| | - Kimitaka Tanaka
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, West-7, North-15, Kita-ku, Sapporo, 060-8638, Japan
| | - Aya Matsui
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, West-7, North-15, Kita-ku, Sapporo, 060-8638, Japan
| | - Toshiaki Shichinohe
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, West-7, North-15, Kita-ku, Sapporo, 060-8638, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, West-7, North-15, Kita-ku, Sapporo, 060-8638, Japan
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A mixed-type intraductal papillary mucinous neoplasm of the pancreas with a histologic combination of gastric and pancreatobiliary subtypes in a 70-year-old woman: a case report. J Med Case Rep 2020; 14:146. [PMID: 32900376 PMCID: PMC7487660 DOI: 10.1186/s13256-020-02464-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/27/2020] [Indexed: 12/12/2022] Open
Abstract
Background Intraductal papillary mucinous neoplasms are rare papillary pancreatic neoplasms arising from major pancreatic ducts, characterized by duct dilation and mucin secretion. They comprise approximately 1% of all exocrine neoplasms and are classified according to their anatomical sites into main duct-type, branch duct-type, and mixed-type intraductal papillary mucinous neoplasms. Histological examination plays a crucial role in distinguishing and classifying intraductal papillary mucinous neoplasms into gastric, intestinal, pancreatobiliary, and oncocytic subtypes. Case presentation We present the case of a 70-year-old Syrian woman who was admitted to our hospital due to an intermittent epigastric pain accompanied by diarrhea and weight loss with a recent diagnosis of diabetes mellitus. Following clinical, laboratory, and radiological examination, distal pancreatectomy involving the body and the tail of the pancreas was performed. Interestingly, histological examination of the resected specimens revealed the diagnosis of a mixed-type intraductal papillary mucinous neoplasm with a unique combination of gastric and pancreatobiliary subtypes. Conclusion To the best of our knowledge, the combination of multiple histological subtypes of intraductal papillary mucinous neoplasms has been recorded in a few studies with reference to the challenging histological detection. Herein, we report a rare case with a significant histological combination, highlighting the difficulties in differential diagnosis due to the absence of ancillary techniques, with a brief review on diagnostic methods, histological characteristics and surgical recommendations.
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Izumo W, Higuchi R, Furukawa T, Yazawa T, Uemura S, Shiihara M, Yamamoto M. Importance of each high-risk stigmata and worrisome features as a predictor of high-grade dysplasia in intraductal papillary mucinous neoplasms of the pancreas. Pancreatology 2020; 20:895-901. [PMID: 32624417 DOI: 10.1016/j.pan.2020.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND High-risk stigmata (HRS) and 'worrisome features' (WFs) are defined as predictive factors for malignancies of intraductal papillary mucinous neoplasms (IPMNs). We performed this study to determine the importance and odds ratio (OR) of each HRS and WFs as predictors for high-grade dysplasia (HGD). METHODS We analyzed 295 patients who underwent pancreatectomy for branch duct and mixed-type IPMN, and evaluated the association between HRS and WFs (as defined by the '2017 Fukuoka Consensus Guidelines') and HGD. RESULTS The proportions of patients with low-grade dysplasia (LGD), HGD, and invasive carcinoma were 47%, 28%, and 25%, respectively. Multivariate analysis comparing patients with LGD and HGD using all HRS and WFs revealed that an enhancing mural nodule ≥5 mm (OR: 4.1), pancreatitis (OR: 2.2), and thickened/enhancing cyst walls (OR: 2.2) were independent predictive factors for HGD. Based on the OR (the former factor is two points and the latter two factors are each one point), the incidence of HGD in patients with none (n = 43), one (n = 82), two (n = 25), three (n = 52), and four (n = 19) of these predictive factors were 9%, 26%, 52%, 62%, and 63%, respectively. Assuming a score of one or higher as a surgical indication, the sensitivity, specificity, positive predict value, and negative predict value of HGD were 95, 38, 44, and 91%. CONCLUSIONS Our derived scoring system using more important factors in HRS and WFs may be useful for predicting HGD and determining surgical indications of IPMN.
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Affiliation(s)
- Wataru Izumo
- Department of Surgery, Institute of Gastroenterology, Tokyo Woman's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Woman's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Toru Furukawa
- Department of Investigative Pathology, Tohoku University Graduate School of Medicine, 2-1 Seiryomachi, Aoba-ku, Sendai, 980-8575, Japan
| | - Takehisa Yazawa
- Department of Surgery, Institute of Gastroenterology, Tokyo Woman's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Shuichiro Uemura
- Department of Surgery, Institute of Gastroenterology, Tokyo Woman's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Masahiro Shiihara
- Department of Surgery, Institute of Gastroenterology, Tokyo Woman's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Woman's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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Aoki Y, Mizuma M, Hata T, Aoki T, Omori Y, Ono Y, Mizukami Y, Unno M, Furukawa T. Intraductal papillary neoplasms of the bile duct consist of two distinct types specifically associated with clinicopathological features and molecular phenotypes. J Pathol 2020; 251:38-48. [PMID: 32100878 DOI: 10.1002/path.5398] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 01/13/2020] [Accepted: 02/11/2020] [Indexed: 12/16/2022]
Abstract
Intraductal papillary neoplasm of the bile duct (IPNB) is a grossly visible papillary biliary neoplasm with morphological variations and occasional invasion. Recently a new classification of IPNB into type 1 and type 2 was proposed in which the type 1 IPNBs consist of fine papillary neoplastic glands and the type 2 IPNBs consist of complex branching glands, seldom with foci of solid-tubular components. However, clinicopathological and molecular characteristics of these types of IPNBs are yet to be identified. We aimed to uncover clinicopathological and molecular characteristics of the types of IPNBs. Thirty-six IPNBs were studied retrospectively. Clinicopathological features as well as molecular alterations of 31 genes were evaluated by means of targeted next-generation sequencing and immunohistochemical examination of expression of mucin and cancer-associated molecules. The 36 IPNBs were classified into 22 of type 1 and 14 of type 2. The type 1 IPNBs were associated with a non-invasive phenotype, intestinal and oncocytic subtypes, development in the intrahepatic bile duct, overt mucin production, and a relatively good prognosis. The type 2 IPNBs were associated with an invasive phenotype, the pancreatobiliary subtype, development within the extrahepatic bile duct, and worse prognosis compared with the type 1 IPNBs. In the molecular analysis, recurrent mutations were found in TP53 (34.3%), KRAS (31.4%), STK11 (25.7%), CTNNB1 (17.1%), APC (14.3%), SMAD4 (14.3%), GNAS (11.4%), PBRM1 (11.4%), ELF3 (8.6%), KMT2C (8.6%), NF1 (8.6%), PIK3CA (8.6%), ARID1A (5.7%), ARID2 (5.7%), BAP1 (5.7%), BRAF (5.7%), EPHA6 (5.7%), ERBB2 (5.7%), ERBB3 (5.7%), KMT2D (5.7%), and RNF43 (5.7%). Mutations in KRAS and GNAS were enriched in the type 1 IPNBs, whereas mutations in TP53, SMAD4, and KMT2C were enriched in the type 2 IPNBs. These results indicate that IPNBs consist of two distinct types of neoplasms specifically associated with clinicopathological features and molecular phenotypes. © 2020 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Yasutaka Aoki
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Investigative Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masamichi Mizuma
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tatsuo Hata
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takeshi Aoki
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yuko Omori
- Department of Investigative Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yusuke Ono
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Yusuke Mizukami
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.,Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toru Furukawa
- Department of Investigative Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
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An integrated analysis of host- and tumor-derived markers for predicting high-grade dysplasia and associated invasive carcinoma of intraductal papillary mucinous neoplasms of the pancreas. Surg Today 2020; 50:1039-1048. [PMID: 32124086 DOI: 10.1007/s00595-020-01982-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 02/11/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To clarify the usefulness of cancer-related inflammation, hypermetabolism, and subsequent host malnutrition biomarkers for predicting the histological grades of intraductal papillary mucinous neoplasms of the pancreas (IPMNs). METHODS The systemic immune-inflammation index (SII), prognostic nutritional index (PNI), and maximum standardized uptake value (SUVmax) on fluorodeoxyglucose-positron emission tomography were compared across 171 resected IPMN cases of different histological grades. The diagnostic performance of each marker and of their combinations for predicting IPMN with high-grade dysplasia (HGD)/associated invasive carcinoma (INV) was also tested. RESULTS Of the 171 IPMNs, the IPMN cases with HGD showed significantly higher values of SII (median 406 vs. 340; P = 0.041) and SUVmax (median 2.5 vs. 2.0; P = 0.001) than those with low-grade dysplasia (LGD). On a multivariate analysis, the SII and SUVmax were both independent markers for predicting HGD/INV. A combination analysis including the tumor- and host-derived markers in combination with imaging findings showed an improved diagnostic performance (area under the curve 0.824; sensitivity 75.9%; specificity 80.0%). CONCLUSIONS The combination of multiple markers of host-derived inflammation and tumor-derived focal hypermetabolism can serve as a predictor for the presence of HGD/INV.
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