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Intraductal papillary mucinous neoplasm.
Hum Pathol 2012; 43(1):1-16HP

Abstract

Intraductal papillary mucinous neoplasm (IPMN) is a grossly visible (≥1 cm), mucin-producing neoplasm that arises in the main pancreatic duct and/or its branches. Patients with intraductal papillary mucinous neoplasm can present with symptoms caused by obstruction of the pancreatic duct system, or they can be asymptomatic. There are 3 clinical subtypes of intraductal papillary mucinous neoplasm: main duct, branch duct, and mixed. Five histologic types of intraductal papillary mucinous neoplasm are recognized: gastric foveolar type, intestinal type, pancreatobiliary type, intraductal oncocytic papillary neoplasm, and intraductal tubulopapillary neoplasm. Noninvasive intraductal papillary mucinous neoplasms are classified into 3 grades based on the degree of cytoarchitectural atypia: low-, intermediate-, and high-grade dysplasia. The most important prognosticator, however, is the presence or absence of an associated invasive carcinoma. Some main duct-intraductal papillary mucinous neoplasms progress into invasive carcinoma, mainly tubular adenocarcinoma (conventional pancreatic ductal adenocarcinoma) and colloid carcinoma. Branch duct-intraductal papillary mucinous neoplasms have a low risk for malignant transformation. Preoperative prediction of the malignant potential of an intraductal papillary mucinous neoplasm is of growing importance because pancreatic surgery has its complications, and many small intraductal papillary mucinous neoplasms, especially branch duct-intraductal papillary mucinous neoplasms, have an extremely low risk of progressing to an invasive cancer. Although most clinical decision making relies on imaging, a better understanding of the molecular genetics of intraductal papillary mucinous neoplasm could help identify molecular markers of high-risk lesions. When surgery is performed, intraoperative frozen section assessment of the pancreatic resection margin can guide the extent of resection. Intraductal papillary mucinous neoplasms are often multifocal, and surgically resected patients should be followed for metachronous disease.

Authors+Show Affiliations

Department of Pathology, Vanderbilt University Medical Center, Nashville, TN 37232 USA.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21777948

Citation

Shi, Chanjuan, and Ralph H. Hruban. "Intraductal Papillary Mucinous Neoplasm." Human Pathology, vol. 43, no. 1, 2012, pp. 1-16.
Shi C, Hruban RH. Intraductal papillary mucinous neoplasm. Hum Pathol. 2012;43(1):1-16.
Shi, C., & Hruban, R. H. (2012). Intraductal papillary mucinous neoplasm. Human Pathology, 43(1), pp. 1-16. doi:10.1016/j.humpath.2011.04.003.
Shi C, Hruban RH. Intraductal Papillary Mucinous Neoplasm. Hum Pathol. 2012;43(1):1-16. PubMed PMID: 21777948.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intraductal papillary mucinous neoplasm. AU - Shi,Chanjuan, AU - Hruban,Ralph H, Y1 - 2011/07/20/ PY - 2011/03/01/received PY - 2011/03/29/revised PY - 2011/04/08/accepted PY - 2011/7/23/entrez PY - 2011/7/23/pubmed PY - 2012/2/1/medline SP - 1 EP - 16 JF - Human pathology JO - Hum. Pathol. VL - 43 IS - 1 N2 - Intraductal papillary mucinous neoplasm (IPMN) is a grossly visible (≥1 cm), mucin-producing neoplasm that arises in the main pancreatic duct and/or its branches. Patients with intraductal papillary mucinous neoplasm can present with symptoms caused by obstruction of the pancreatic duct system, or they can be asymptomatic. There are 3 clinical subtypes of intraductal papillary mucinous neoplasm: main duct, branch duct, and mixed. Five histologic types of intraductal papillary mucinous neoplasm are recognized: gastric foveolar type, intestinal type, pancreatobiliary type, intraductal oncocytic papillary neoplasm, and intraductal tubulopapillary neoplasm. Noninvasive intraductal papillary mucinous neoplasms are classified into 3 grades based on the degree of cytoarchitectural atypia: low-, intermediate-, and high-grade dysplasia. The most important prognosticator, however, is the presence or absence of an associated invasive carcinoma. Some main duct-intraductal papillary mucinous neoplasms progress into invasive carcinoma, mainly tubular adenocarcinoma (conventional pancreatic ductal adenocarcinoma) and colloid carcinoma. Branch duct-intraductal papillary mucinous neoplasms have a low risk for malignant transformation. Preoperative prediction of the malignant potential of an intraductal papillary mucinous neoplasm is of growing importance because pancreatic surgery has its complications, and many small intraductal papillary mucinous neoplasms, especially branch duct-intraductal papillary mucinous neoplasms, have an extremely low risk of progressing to an invasive cancer. Although most clinical decision making relies on imaging, a better understanding of the molecular genetics of intraductal papillary mucinous neoplasm could help identify molecular markers of high-risk lesions. When surgery is performed, intraoperative frozen section assessment of the pancreatic resection margin can guide the extent of resection. Intraductal papillary mucinous neoplasms are often multifocal, and surgically resected patients should be followed for metachronous disease. SN - 1532-8392 UR - https://www.unboundmedicine.com/medline/citation/21777948/Intraductal_papillary_mucinous_neoplasm_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0046-8177(11)00157-2 DB - PRIME DP - Unbound Medicine ER -