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Panteleev VI, Kaldarov AR, Gorin DS, Kriger AG. [Combination of intraductal papillary mucinous neoplasm with other cystic pancreatic tumors]. Khirurgiia (Mosk) 2021:80-83. [PMID: 33570359 DOI: 10.17116/hirurgia202102180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cystic tumors of the pancreas are uncommon entities. Synchronic occurrence of intraductal papillary mucinous neoplasm (IPMN) and other pancreatic tumors is extremely rare. Two patients with this diagnosis are reported in the manuscript. Cystic tumors of the pancreas can rarely occur in various combinations while malignancy potential of each neoplasm may be different. Surgery depends on localization and type of each tumor and must be determined individually.
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Affiliation(s)
| | | | - D S Gorin
- Vishnevsky Centre of surgery, Moscow, Russia
| | - A G Kriger
- Vishnevsky Centre of surgery, Moscow, Russia
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Manuel-Vazquez A, Ramia JM, Latorre-Fragua R, Valle-Rubio A, Arteaga-Peralta V, Ramiro-Pérez C, de la Plaza-Llamas R. Pancreatic Neuroendocrine Tumors and Intraductal Papillary Mucinous Neoplasm of the Pancreas: A Systematic Review. Pancreas 2018; 47:551-555. [PMID: 29683974 DOI: 10.1097/mpa.0000000000001048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study aimed to identify factors that explain the association of intraductal papillary mucinous neoplasms-pancreatic neuroendocrine tumors (IPMNs-PNETs), radiological characteristics, and factors that might guide therapy. METHODS We performed a systematic review of the literature to search for articles on concurrent IPMN-PNET, mixed endocrine-exocrine pancreatic tumors, and/or PNET with an intraductal growth pattern. RESULTS A review of the literature suggests that there is some confusion about association of IPMNs-PNETs. Regarding this association, the studies collected data from 32 patients. Eleven patients presented concurrent tumors, 9 mixed endocrine-exocrine tumors, and no data were available in the remaining 7. In addition, the relationship IPMN-PNET focuses not only on the coexistence of the 2 lesions, but also on the possibility of the intraductal growth of the endocrine lesion. In the literature, in 4 cases, the preoperative radiological diagnosis had been IPMN. CONCLUSIONS Intraductal papillary mucinous neoplasms and PNETs may be associated in a number of scenarios. The association may be due to the concurrent existence of independent lesions, may be a mixed endocrine-exocrine tumor, or may be due to intraductal growth of the endocrine lesion. But the literature is confusing. It is not known whether the association is accidental or whether there is an etiological reason. Further studies are needed to investigate this scenario.
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Affiliation(s)
- Alba Manuel-Vazquez
- From the Department of General and Digestive Surgery, University Hospital of Guadalajara, Guadalajara, Spain
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Intraductal papillary mucinous neoplasms of the pancreas with concurrent pancreatic and periampullary neoplasms. Eur J Surg Oncol 2016; 42:197-204. [DOI: 10.1016/j.ejso.2015.10.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 10/14/2015] [Accepted: 10/23/2015] [Indexed: 01/12/2023] Open
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4
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Kasugai H, Tajiri T, Takehara Y, Mukai S, Tanaka JI, Kudo SE. Intraductal tubulopapillary neoplasms of the pancreas: case report and review of the literature. J NIPPON MED SCH 2013; 80:224-9. [PMID: 23832407 DOI: 10.1272/jnms.80.224] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A 69-year-old woman was referred to our hospital after incidental identification of a pancreatic mass during follow-up for diabetes mellitus. Various imaging examinations showed a tumor in the main pancreatic duct, without apparent hypersecretion of mucin. Brush cytologic examination revealed class V disease (adenocarcinoma). Because preoperative examination suggested an intraductal neoplasm with associated invasive cancer, total pancreatectomy was performed. Histological examination, based on current World Health Organization classifications, suggested a diagnosis of intraductal tubulopapillary neoplasm. A small cystic lesion adjacent to the intraductal tubulopapillary neoplasm was incidentally diagnosed as serous cystadenoma. The patient has remained well without recurrence as of 24 months postoperatively. Computed tomography and magnetic resonance imaging of the intraductal tubulopapillary neoplasm suggested ductal cell carcinoma of the pancreas rather than intraductal papillary mucinous neoplasm. Distinguishing intraductal tubulopapillary neoplasm from ductal cell carcinoma is clinically important, as intraductal tubulopapillary neoplasm has a favorable prognosis after curative resection.
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Affiliation(s)
- Hisashi Kasugai
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan.
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5
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Endoscopic ultrasound identifies synchronous pancreas cystic lesions not seen on initial cross-sectional imaging. Pancreas 2011; 40:1070-2. [PMID: 21705942 DOI: 10.1097/mpa.0b013e31821f65e3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES A retrospective review conducted to determine the utility of endoscopic ultrasound (EUS) examination of the pancreas after initial pancreatic cyst detection with cross-sectional imaging. METHODS A retrospective review of 145 patients referred for EUS for evaluation of pancreas cystic lesions. Initial cross-sectional imaging reports were reviewed and compared to subsequent EUS findings. Findings evaluated included cyst size, number, multifocality, presence in different surgical fields, cyst wall nodularity, main pancreatic duct (PD) dilation, communication with PD, and features suggestive of serous cystadenoma. RESULTS Compared to computed tomographic scan, EUS more frequently identified pancreatic cystic lesion multifocality (47% vs 13%, P < 0.0001) and their presence in different surgical fields (33.3% vs 4.2%, P < 0.0001). Compared to magnetic resonance imaging, EUS was superior in identifying multifocality (58% vs 34%, P = 0.0002) and the presence of cysts in different surgical fields (42% vs. 26%, P = 0.021). Malignancy was suspected or confirmed in 3 patients by EUS fine-needle aspiration cytology, not suspected by cross-sectional imaging. Endoscopic ultrasound identified unappreciated features of serous cystadenomas in 10 patients. CONCLUSION Endoscopic ultrasound identified synchronous pancreatic cystic lesions unappreciated by initial cross-sectional imaging, with undetected cysts frequently outside of typical resection margins. In addition, EUS identified the presence of unappreciated high- or low-risk characteristics in a small percentage of patients.
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Kwak HJ, Kim YK, Cho BH, Moon WS. Simultaneous Pancreatic Serous Microcystic Adenoma and Intraductal Papillary Mucinous Tumor of the Pancreas - A Case Report -. KOREAN JOURNAL OF PATHOLOGY 2011. [DOI: 10.4132/koreanjpathol.2011.45.s1.s29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Young Kon Kim
- Department of Radiology, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Baik Hwan Cho
- Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea
- Department of Surgery, Chonbuk National University Medical School, Jeonju, Korea
| | - Woo Sung Moon
- Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea
- Department of Pathology, Chonbuk National University Medical School, Jeonju, Korea
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Khan MA, Verma GR. Solitary true cyst of pancreas: report of a case and review of literature. J Gastrointest Cancer 2010; 41:96-100. [PMID: 20369308 DOI: 10.1007/s12029-010-9139-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
CONTEXT Solitary true cysts of the pancreas in adults are extremely rare, and only few cases have been reported in the literature. The etiology and natural history of these lesions remain unknown, and treatment is not standardized. We describe an additional resected case. CASE REPORTS A 55-year-old female who presented to us with a history of heaviness and pain in right upper abdomen for 1 year. CT scan of abdomen showed a large unilocular cyst in the region of the head of the pancreas. The patient underwent pancreatico-duodenectomy with binding pancreaticojejunostomy. The histology of cyst revealed true unilocular pancreatic cyst lined by cuboidal epithelium. She is well after 3 years of follow-up. CONCLUSIONS A preoperative work-up alone does not always allow an accurate diagnosis, but it is useful in determining lesion characteristics and guiding therapeutic decision-making. When surgery is indicated, a limited resection is warranted in most cases.
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Abstract
The increasing use of radiological imaging has led to greater detection of small and asymptomatic cystic lesions of the pancreas. Most are resectable, but not all are neoplastic. This review provides an update on the histopathology, immunohistochemistry, molecular biology, pathogenesis and management of cystic neoplasms of the exocrine pancreas. These include the serous, the mucinous cystic, the intraductal papillary mucinous and the solid pseudopapillary neoplasms. Recently reported variants are described and very rare cystic variants of other pancreatic epithelial and mesenchymal neoplasms are briefly mentioned.
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MESH Headings
- Biomarkers, Tumor/analysis
- Carcinoma, Pancreatic Ductal/chemistry
- Carcinoma, Pancreatic Ductal/pathology
- Carcinoma, Pancreatic Ductal/therapy
- Cystadenocarcinoma/chemistry
- Cystadenocarcinoma/pathology
- Cystadenocarcinoma/therapy
- Cystadenocarcinoma, Mucinous/chemistry
- Cystadenocarcinoma, Mucinous/pathology
- Cystadenocarcinoma, Mucinous/therapy
- Cystadenocarcinoma, Papillary/chemistry
- Cystadenocarcinoma, Papillary/pathology
- Cystadenocarcinoma, Papillary/therapy
- Cystadenocarcinoma, Serous/chemistry
- Cystadenocarcinoma, Serous/pathology
- Cystadenocarcinoma, Serous/therapy
- Humans
- Immunohistochemistry
- Pancreas, Exocrine/chemistry
- Pancreas, Exocrine/pathology
- Pancreatic Ducts/chemistry
- Pancreatic Ducts/pathology
- Pancreatic Neoplasms/chemistry
- Pancreatic Neoplasms/pathology
- Pancreatic Neoplasms/therapy
- Precancerous Conditions/chemistry
- Precancerous Conditions/pathology
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Affiliation(s)
- F Campbell
- Department of Pathology, Royal Liverpool University Hospital, Liverpool, UK.
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Goh BKP, Tan YM, Chung YFA, Chow PKH, Cheow PC, Thng CH, Mesenas S, Wong WK, Ooi LLPJ. Pancreatic cysts: a proposed management algorithm based on current evidence. Am J Surg 2007; 193:749-55. [PMID: 17512290 DOI: 10.1016/j.amjsurg.2006.07.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2006] [Revised: 07/28/2006] [Accepted: 07/28/2006] [Indexed: 01/07/2023]
Abstract
BACKGROUND Currently, the management strategy of pancreatic cyst (PC) remains controversial because of the inability to diagnose this type of cyst accurately and the limited knowledge of its natural history. Previously, many clinicians have advocated an aggressive resectional policy. This approach is no longer appropriate, and the number of PCs detected incidentally has increased. This study reviews the present literature and attempts to provide a management algorithm of pancreatic cysts based on currently available evidence. METHODS A Medline search was conducted to identify studies investigating PC, with particular emphasis placed on studies addressing its diagnosis and management. Additional articles were obtained from the reference lists of key articles and recent reviews. COMMENTS Based on current evidence, the optimal management of PC remains an art and should be individualized based on the risk-benefit ratio of surgery, which is influenced by multiple factors, such as the patient's potential life expectancy, surgical risk; and malignant potential of the cyst. Our proposed management algorithm is based on an individual's predicted risk-benefit ratio of surgery. Prospective evaluation of the algorithm is needed to determine its integrity.
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Affiliation(s)
- Brian K P Goh
- Department of Surgery, Singapore General Hospital, Outram Road, Singapore 169608.
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Goh BKP, Ooi LLPJ, Kumarasinghe MP, Tan YM, Cheow PC, Chow PKH, Chung YFA, Wong WK. Clinicopathological features of patients with concomitant intraductal papillary mucinous neoplasm of the pancreas and pancreatic endocrine neoplasm. Pancreatology 2006; 6:520-6. [PMID: 17124434 DOI: 10.1159/000097361] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2005] [Accepted: 02/21/2006] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIMS The occurrence of concomitant pancreatic endocrine neoplasm (PEN) and intraductal papillary neoplasm (IPMN) of the pancreas has rarely been reported. We describe our experience with 3 patients with this association and review the existing literature. METHODS From 1990 to 2005, 65 patients who underwent surgery for a PEN or IPMN were retrospectively reviewed. Forty-three patients had a PEN, 19 had an IPMN and 3 had both an IPMN and PEN. The 3 patients with concomitant IPMN and PEN are the focus of the current study and their clinicopathological features are reported together with 7 patients previously reported in the literature. RESULTS There were 10 patients with a median age of 62 years (range 40-73). The male:female ratio was equal. Seven of 10 patients were symptomatic and the most common symptoms were abdominal pain (n = 5), jaundice (n = 2) and loss of weight (n = 2). The median size of the endocrine neoplasms was 14 mm (range 2-30) and they occurred in the head (n = 3), body (n = 2) and tail (n = 5). Seven of the PENs were classified as benign, 2 were potentially malignant, and 1 was frankly malignant with lymph node involvement. None of the endocrine neoplasms were functioning. The IPMNs were found in the tail (n = 4), head (n = 3), head and body (n = 1), body (n = 1) and the entire pancreas (n = 1). Five of these neoplasms were benign, 2 were borderline and 3 were malignant (1 carcinoma in situ). CONCLUSION The occurrence of concomitant IPMN and PEN is more frequent than would be expected. However, it is difficult in the present analysis to determine if this association is more than just fortuitous.
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MESH Headings
- Adenocarcinoma, Mucinous/metabolism
- Adenocarcinoma, Mucinous/pathology
- Adenocarcinoma, Mucinous/surgery
- Adult
- Aged
- Biomarkers, Tumor/metabolism
- Carcinoma, Neuroendocrine/metabolism
- Carcinoma, Neuroendocrine/pathology
- Carcinoma, Neuroendocrine/surgery
- Carcinoma, Pancreatic Ductal/metabolism
- Carcinoma, Pancreatic Ductal/pathology
- Carcinoma, Pancreatic Ductal/surgery
- Carcinoma, Papillary/metabolism
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/surgery
- Chromogranins/metabolism
- Female
- Humans
- Male
- Middle Aged
- Neoplasms, Second Primary/metabolism
- Neoplasms, Second Primary/pathology
- Neoplasms, Second Primary/surgery
- Pancreatic Neoplasms/metabolism
- Pancreatic Neoplasms/pathology
- Pancreatic Neoplasms/surgery
- Synaptophysin/metabolism
- Tomography, X-Ray Computed
- Treatment Outcome
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Affiliation(s)
- Brian K P Goh
- Department of Surgery, Singapore General Hospital, Singapore, Singapore
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Goh BKP, Tan YM, Cheow PC, Chung YFA, Chow PKH, Wong WK, Ooi LLPJ. Cystic lesions of the pancreas: an appraisal of an aggressive resectional policy adopted at a single institution during 15 years. Am J Surg 2006; 192:148-54. [PMID: 16860621 DOI: 10.1016/j.amjsurg.2006.02.020] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2005] [Revised: 02/13/2006] [Accepted: 02/13/2006] [Indexed: 12/29/2022]
Abstract
BACKGROUND Although an aggressive resectional approach toward pancreatic cysts has been advocated in the past, many clinicians now deem this therapeutic strategy impractical given the rapidly increasing incidence of incidentally detected pancreatic cystic lesions. The aim of this study was to review the aggressive resectional policy toward pancreatic cysts adopted at our institution during the past 15 years. METHODS One hundred nine consecutive patients who underwent surgical resection of a cystic lesion of the pancreas during a 15-year period were retrospectively reviewed. To determine subsets of patients at lower risk of having a malignant cyst, the clinicopathologic features (in particular, the malignant potential) of these patients were compared as a function of 3 variables, ie, presence of symptoms, patient age, and cyst size, using univariate analyses. Results were expressed as median and range and P < .05 was considered statistically significant. RESULTS Forty-three (39%) of 109 patients were asymptomatic. Incidental cysts were smaller (28 [10 to 240] vs 59 [10 to 200] mm, P < .001) and were found in older patients (55.0 [18 to 77] vs 45.5 [14 to 82] years, P = .003). Overall, 14% of asymptomatic cysts, versus 35% of symptomatic cysts, were malignant (P = .016). Incidental cysts were also less likely to be premalignant or malignant compared with symptomatic cysts (47% vs 70%, P = .015). Twenty (18%) patients were elderly (73.0 [70 to 82] years old). Elderly patients had a more equal sex distribution (45% vs 76% female, P = .005) and had smaller cysts (26 [10 to 200] vs 55 [10 to 240] mm, P = .003) that involved the head of the pancreas more frequently (8 [40%] vs 17 [19%], P = .045) compared with their younger counterparts. The cohort of elderly patients also had a higher median American Society of Anesthesiologists score (2 [1 to 3] vs 1 [1 to 3], P < .001), and a higher proportion had undergone a "more" major procedure (Whipple's or total pancreatectomy) (55% vs 18%, P < .001). Not unexpectedly, surgical morbidity in the elderly was significantly higher (10 [50%] vs 24 [27%], P = .045). The operative mortality in both groups was not significantly different (1 [5%] vs 1 [1%], P = .324). The proportion of premalignant or malignant lesions in elderly patients was also similar to that in younger patients (11 [55%] vs 55 [62%], P = .574). The size of a cyst in asymptomatic patients had no correlation with its potential for malignancy. CONCLUSIONS Reliance on preoperative characteristics alone such as the presence of symptoms, cyst size, and patient age are not sufficiently reliable in determining the malignant potential and thus management approach toward pancreatic cysts.
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Affiliation(s)
- Brian K P Goh
- Department of Surgery, Singapore General Hospital, Singapore
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Suarez-Vilela D, Izquierdo-Garcia FM, Iglesias-Dominguez F. A malignant mucinous cystic neoplasm arising within a mycrocystic adenoma of the pancreas. Virchows Arch 2006; 449:385-8. [PMID: 16896893 DOI: 10.1007/s00428-006-0243-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2006] [Accepted: 05/30/2006] [Indexed: 11/26/2022]
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Kwan V, Church N, Biankin S, Norton ID, Jones DB, Falk GL. Serous cystadenoma causing biliary obstruction with synchronous pancreatic intraepithelial neoplasia. Gastrointest Endosc 2006; 64:291-4. [PMID: 16860093 DOI: 10.1016/j.gie.2006.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2005] [Accepted: 02/03/2006] [Indexed: 02/08/2023]
Affiliation(s)
- Vu Kwan
- Department of Gastroenterology, Concord Hospital, Sydney, Australia
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Ban S, Naitoh Y, Ogawa F, Shimizu Y, Shimizu M, Yasumoto A, Koyama I. Intraductal papillary mucinous neoplasm (IPMN) of the gastric-type with focal nodular growth of the arborizing papillae: a case of high-grade transformation of the gastric-type IPMN. Virchows Arch 2006; 449:112-6. [PMID: 16639605 DOI: 10.1007/s00428-006-0214-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2006] [Accepted: 03/28/2006] [Indexed: 01/08/2023]
Abstract
We present a case of intraductal papillary mucinous neoplasm (IPMN) of the pancreas, demonstrating a process of high-grade transformation of the gastric-type IPMN. An 83-year-old Japanese woman underwent pylorus-preserving pancreatoduodenectomy for removal of a multicystic mass of the pancreas head, which had been followed up for 7 years. The removed tumor was a low-grade gastric-type IPMN spreading in the branch ducts, focally forming an intraluminal nodular lesion. The nodular lesion was comprised of arborizing papillotubular proliferation of cuboidal to columnar epithelia with high-grade atypia, and was characterized by diffuse MUC1 expression and a gastric mucin phenotype (focal MUC5AC and MUC6 expressions). Therefore, the nodular lesion was consistent with the pancreatobiliary-type IPMN, and the present case suggests that the low-grade gastric-type IPMN may progress to a focal intraductal carcinoma over the years, and the pancreatobiliary-type IPMN may be one of the forms of such high-grade transformation of the gastric-type IPMN. One of the cystic lesions was an oligocystic-type serous cystic neoplasm (serous cystadenoma), which might be an incidental concomitance or have a common basis.
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Affiliation(s)
- Shinichi Ban
- Department of Pathology, Saitama Medical School, 38 Morohongo, Moroyama, Iruma, Saitama 350-0495, Japan.
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