Preoperative evaluation of invasive and noninvasive intraductal papillary-mucinous neoplasms of the pancreas: clinical, radiological, and pathological analysis of 123 cases.
ABSTRACT We aimed to investigate preoperative findings that are useful to distinguish intraductal papillary-mucinous neoplasm (IPMN) subtypes.
One hundred twenty-three patients who underwent pancreatectomy for IPMN were analyzed clinicopathologically and radiologically. Invasive IPM carcinomas (IPMCs) were subdivided into early-stage nonaggressive (minimally invasive IPMC [MI-IPMC]) and more advanced and aggressive (invasive carcinoma originating in IPMC [IC-IPMC]) subtypes according to our recently proposed pathological criteria.
The lesions consisted of 27 IPMNs with low-grade dysplasia, 14 IPMNs with moderate dysplasia, 21 IPMNs with high-grade dysplasia, 30 MI-IPMCs, and 31 IC-IPMCs. Multidetector-row computed tomography detected a component of invasive carcinoma in IC-IPMC with 86% sensitivity and 100% specificity. In patients with IPMNs other than IC-IPMC, multivariate analysis demonstrated 3 significant predictive factors of malignancy: IPMN size (>40 mm), IPMN duct type (main pancreatic duct or mixed type), and the presence of a mural nodule or thick septum. The diagnostic score obtained using these 3 factors showed a strong correlation with the presence of malignancy.
For preoperative evaluation of patients with IPMN, it is recommended to rule out IC-IPMC using multidetector-row computed tomography and then to categorize IPMN other than IC-IPMC according to malignant potential based on the diagnostic score.
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ABSTRACT: There are few data on blood group (BG) types and types of pancreatic cancers. The aims of this study were to study BG types and BG-antigens in pancreatic intraductal papillary mucinous neoplasms (IPMNs). BG type and tumor BG-antigen (glycoprotein) expression (studied by immunohistochemistry on tissue microarrays) were analyzed with regard to characteristics of 101 surgically resected pancreatic IPMNs. Non-O BG type predicted invasive carcinoma independently from high serum CA19-9 and male gender. BG type A was observed more frequently in women than in men. Chronic pancreatitis was more frequently seen in patients with BG type B or AB. Aberrant tumor expression (with regard to BG type) of loss of A antigen expression type occurred in 15.0% of IPMNs and of loss of B antigen expression type in 62.5% of IPMNs. Intraneoplasm BG-antigen expression was not related to dysplasia grade or invasion. The results of the study suggest that in pancreatic IPMN, non-O BG type predicted invasive carcinoma, whereas for intratumor BG-antigen expression no specific patterns were detected with regard to the progression of glandular epithelial dysplasia or invasion.Hepatobiliary & pancreatic diseases international: HBPD INT 02/2014; 13(1):74-80. · 1.26 Impact Factor
- Pancreas 10/2013; 42(7):1193-1195. · 2.95 Impact Factor
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ABSTRACT: Risk of malignancy in main duct intraductal papillary mucinous neoplasm (MD-IPMN) ranges from 36% to 100% in the literature. Although surgical resection is recommended for all MD-IPMNs, the risk of malignancy based on main pancreatic duct (MPD) size alone remains unclear. To assess the prevalence of malignancy in symptomatic and asymptomatic patients with pure MD-IPMN based on MPD size. Single-center retrospective study of prospectively collected data. Tertiary referral center. Fifty-two patients with pure low-risk MD-IPMN. Clinical, endoscopic, radiographic, and pathologic data were reviewed. Prevalence of malignancy in patients with pure MD-IPMN based on histopathology of resected lesions. Sixteen asymptomatic patients had pure MD-IPMN on surgical pathology, 4 (25%) with malignant disease, compared with 25 of 36 symptomatic patients (69%) with pure MD-IPMN. Logistic regression identified symptoms and MPD size as predictors of malignancy. Receiver operating characteristic curve analysis demonstrated that MPD size (optimal cutoff of 8 mm) produced the greatest area under the curve to discriminate between benign and malignant MD-IPMN (.83; 95% CI, .72-.94). MPD size greater than 8 mm has a relative risk of 2.8 for malignancy (95% CI, 1.6-4.9). Retrospective, single-center study at a tertiary referral hospital. Study population included only patients who underwent surgical resection. Asymptomatic MD-IPMN patients with a duct size of no more than 8 mm have a lower prevalence of malignancy and may represent a distinct group of patients with less aggressive biologic behavior. Further studies are needed to confirm our observations.Gastrointestinal endoscopy 10/2013; · 6.71 Impact Factor