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Review
. 2012 Summer;5(3):123-31.

Focus on the intraductal papillary mucinous neoplasm of the pancreas

Fernando Gallucci  1 , Assunta Langellotto  1 , Rosaria De Ritis  2 , Generoso Uomo  1
Affiliations
Review

Focus on the intraductal papillary mucinous neoplasm of the pancreas

Fernando Gallucci et al. Gastroenterol Hepatol Bed Bench. 2012 Summer.

Abstract

Intraductal papillary mucinous neoplasms (IPMNs) are rare pancreatic tumours, accounting for less of 1-2% of all neoplasms of the gland. Main characteristics of IPMNs are their favourable prognosis as these pre-malignant or frankly malignant lesions are usually slow-growing tumours and radical surgery is frequently possible. According with the localization of the lesions, three different entities are identified: the main-duct IPMN (type I), the branch-duct IPMN (type II) and the mixed type (type III, involving both the main pancreatic duct and side branches). IMPNs do not present pathognomonic signs or symptoms. Obstruction of the main pancreatic duct system may cause abdominal pain and acute pancreatitis (single or recurrent episodes). The tumour may be incidentally discovered in asymptomatic patients, particularly in those with branch-duct IPMNs. In clinical practice, any non-inflammatory cystic lesion of the pancreas should be considered as possible IPMN. Computed tomography, magnetic resonance imaging with cholangiopancreatography and endoscopic ultrasonography can localize IPMN and assess its morphology and size. The choice between non-operative and surgical management strictly depends from the risk of malignancy and of the definitively distinction between benign and malignant IPMNs. Main-duct IPMNs are at higher risk of malignant degeneration, especially in older patients; as a consequence no doubt does not exist as concerns the need of surgery for IPMN type I and III. A less aggressive surgical approach as well as the possibility of conservative management have been suggested for asymptomatic, small size (< 3-3.5 cm), branch-duct IPMN.

Keywords: Diagnosis; Mucinous pancreatic tumour; Pancreatic cyst; Pancreatic neoplasm; Treatment.

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Figures

Figure 1
Figure 1
Duodenoscopy: characteristic mucin extrusion through the ampulla of Vater
Figure 2
Figure 2
Contrast-enhanced CT scan; main-duct IPMN: presence of multiple cystic lesions at the head of the pancreas (main-duct IPMN)
Figure 3
Figure 3
Magnetic Resonance Cholangio-Pancreatography; IPMN of the distal main pancreatic duct (tail of the pancreas)
Figure 4
Figure 4
Magnetic Resonance: axial and cholangio-pancreatographic sequences in main-duct IPMN of the pancreatic head
Figure 5
Figure 5
Magnetic Resonance: axial and cholangio-pancreatographic sequences in mixed-type IPMN of the pancreatic head (multiple side branches lesions and involvement of the main pancreatic duct at the tail level)
Figure 6
Figure 6
Magnetic Resonance Cholangio-Pancreatography with secretin stimulation (1 IU/Kg/body weight); branch-duct IPMN (uncinate process): presence of filling defects within the cystic lesion representing nodules and papillary projections
Figure 7
Figure 7
Endoscopic ultrasonography; IPMN of the main pancreatic duct at the head of the gland presenting as multiple anechoic lesions
See this image and copyright information in PMC

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