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The distribution of atypical epithelium in main-duct type intraductal papillary mucinous neoplasms of the pancreas

  • Original article
  • Published:
Journal of Hepato-Biliary-Pancreatic Sciences

Abstract

Background/Purpose

The purpose of this study was to obtain the fundamental data necessary to discuss the appropriate operative mode for the resection of main-duct type intraductal papillary mucinous neoplasms (mIPMNs) of the pancreas.

Methods

In 23 patients who underwent total pancreatectomy with preoperative and postoperative diagnoses of mIPMN, the imaging studies and clinicopathological data were collected. The whole pancreatic specimen was histologically evaluated, and the distribution of atypical epithelium was mapped on a schema.

Results

Pathological examination of the specimens revealed that 18 patients had carcinoma in the pancreas; 8 patients had invasive lesions and one patient had lymph node metastasis. Specimens from 5 patients did not bear carcinoma lesions but had widespread borderline lesions in the pancreas. The mapping of lesions in the pancreatic specimens revealed that, at least, borderline or higher lesions were present both in the head and distal pancreas in all patients. In the majority of the specimens, lesions from adenoma to carcinoma co-existed on the same slide, and there were normal cell intervals between the malignant lesions.

Conclusion

We conclude that total pancreatectomy should be performed for mIPMN when dilatation of the main duct suggests possible spread of the lesion to the whole pancreas.

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References

  1. Ohhashi K, Murakami Y, Maruyama M, Takekoshi T, Ohta H, Ohhashi I, et al. Four cases of mucous secreting pancreatic cancer. Prog Dig Endosc. 1982;20:348–51.

    Google Scholar 

  2. Furukawa T, Takahashi T, Kobari M, Matsuno S. The mucus-hypersecreting tumor of the pancreas. Development and extension visualized by three-dimensional computerized mapping. Cancer. 1992;70:1505–13.

    Article  PubMed  CAS  Google Scholar 

  3. Tanaka M, Chari S, Adsay V, Fernandez-del Castillo C, Falconi M, Shimizu M, et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology. 2006;6:17–32.

    Article  PubMed  Google Scholar 

  4. Longnecker D, Adler G, Hruban R, Kloppel G. Intraductal papillary-mucinous neoplasm of the pancreas. Lyon: IARC press; 2000.

    Google Scholar 

  5. Japan Pancreas Society. General rules for the study of pancreatic cancer. Tokyo: Kanehara; 2002.

  6. Kobari M, Egawa S, Shibuya K, Shimamura H, Sunamura M, Takeda K, et al. Intraductal papillary mucinous tumors of the pancreas comprise 2 clinical subtypes: differences in clinical characteristics and surgical management. Arch Surg. 1999;134:1131–6.

    Article  PubMed  CAS  Google Scholar 

  7. Terris B, Ponsot P, Paye F, Hammel P, Sauvanet A, Molas G, et al. Intraductal papillary mucinous tumors of the pancreas confined to secondary ducts show less aggressive pathologic features as compared with those involving the main pancreatic duct. Am J Surg Pathol. 2000;24:1372–7.

    Article  PubMed  CAS  Google Scholar 

  8. Doi R, Fujimoto K, Wada M, Imamura M. Surgical management of intraductal papillary mucinous tumor of the pancreas. Surgery. 2002;132:80–5.

    Article  PubMed  Google Scholar 

  9. Matsumoto T, Aramaki M, Yada K, Hirano S, Himeno Y, Shibata K, et al. Optimal management of the branch duct type intraductal papillary mucinous neoplasms of the pancreas. J Clin Gastroenterol. 2003;36:261–5.

    Article  PubMed  Google Scholar 

  10. Kitagawa Y, Unger T, Taylor S, Kozarek R, Traverso L. Mucus is a predictor of better prognosis and survival in patients with intraductal papillary mucinous tumor of the pancreas. J Gastrointest Surg. 2003;7:12–8.

    Article  PubMed  Google Scholar 

  11. Sugiyama M, Izumisato Y, Abe N, Masaki T, Mori T, Atomi Y. Predictive factors for malignancy in intraductal papillary-mucinous tumours of the pancreas. Br J Surg. 2003;90:1244–9.

    Article  PubMed  CAS  Google Scholar 

  12. Sohn T, Yeo C, Cameron J, Hruban R, Fukushima N, Campbell K, Lillemoe K. Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Ann Surg. 2004;239:788–97.

    Article  PubMed  Google Scholar 

  13. Salvia R, Fernández-del Castillo C, Bassi C, Thayer S, Falconi M, Mantovani W, et al. Main-duct intraductal papillary mucinous neoplasms of the pancreas: clinical predictors of malignancy and long-term survival following resection. Ann Surg. 2004;239:678–85.

    Article  PubMed  Google Scholar 

  14. Choi B, Kim T, Kim A, Kim K, Park S, Kim P, et al. Differential diagnosis of benign and malignant intraductal papillary mucinous tumors of the pancreas: MR cholangiopancreatography and MR angiography. Korean J Radiol. 2003;4:157–62.

    Article  PubMed  Google Scholar 

  15. Kim S, Park K, Lee Y, Lee S, Seo D, Lee S, et al. Intraductal papillary mucinous neoplasm of the pancreas: clinical characteristics and treatment outcomes of 118 consecutive patients from a single center. J Hepatobiliary Pancreat Surg. 2008;15:183–8.

    Article  PubMed  Google Scholar 

  16. Manfredi R, Graziani R, Motton M, Mantovani W, Baltieri S, Tognolini A, et al. Main pancreatic duct intraductal papillary mucinous neoplasms: accuracy of MR imaging in differentiation between benign and malignant tumors compared with histopathologic analysis. Radiology. 2009;253:106–15.

    Article  PubMed  Google Scholar 

  17. Chari S, Yadav D, Smyrk T, DiMagno E, Miller L, Raimondo M, et al. Study of recurrence after surgical resection of intraductal papillary mucinous neoplasm of the pancreas. Gastroenterology. 2002;123:1500–7.

    Article  PubMed  Google Scholar 

  18. Maire F, Hammel P, Terris B, Paye F, Scoazec J, Cellier C, et al. Prognosis of malignant intraductal papillary mucinous tumours of the pancreas after surgical resection. Comparison with pancreatic ductal adenocarcinoma. Gut. 2002;51:717–22.

    Article  PubMed  CAS  Google Scholar 

  19. Raimondo M, Tachibana I, Urrutia R, Burgart L, DiMagno E. Invasive cancer and survival of intraductal papillary mucinous tumors of the pancreas. Am J Gastroenterol. 2002;97:2553–8.

    Article  PubMed  Google Scholar 

  20. Wada K, Kozarek R, Traverso L. Outcomes following resection of invasive and noninvasive intraductal papillary mucinous neoplasms of the pancreas. Am J Surg. 2005;189:632–6.

    Article  PubMed  Google Scholar 

  21. Jang J, Kim S, Ahn Y, Yoon Y, Choi M, Lee K, et al. Multicenter analysis of clinicopathologic features of intraductal papillary mucinous tumor of the pancreas: is it possible to predict the malignancy before surgery? Ann Surg Oncol. 2005;12:124–32.

    Article  PubMed  Google Scholar 

  22. Raut C, Cleary K, Staerkel G, Abbruzzese J, Wolff R, Lee J, et al. Intraductal papillary mucinous neoplasms of the pancreas: effect of invasion and pancreatic margin status on recurrence and survival. Ann Surg Oncol. 2006;13:582–94.

    Article  PubMed  Google Scholar 

  23. Schnelldorfer T, Sarr M, Nagorney D, Zhang L, Smyrk T, Qin R, et al. Experience with 208 resections for intraductal papillary mucinous neoplasm of the pancreas. Arch Surg. 2008;143:639–46.

    Article  PubMed  Google Scholar 

  24. Nara S, Shimada K, Kosuge T, Kanai Y, Hiraoka N. Minimally invasive intraductal papillary-mucinous carcinoma of the pancreas: clinicopathologic study of 104 intraductal papillary-mucinous neoplasms. Am J Surg Pathol. 2008;32:243–55.

    Article  PubMed  Google Scholar 

  25. Stauffer J, Nguyen J, Heckman M, Grewal M, Dougherty M, Gill K, et al. Patient outcomes after total pancreatectomy: a single centre contemporary experience. HPB (Oxford). 2009;11:483–92.

    Google Scholar 

  26. Yang A, Melstrom L, Bentrem D, Ujiki M, Wayne J, Strouch M, et al. Outcomes after pancreatectomy for intraductal papillary mucinous neoplasms of the pancreas: an institutional experience. Surgery. 2007;142:529–34.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

We thank the following individuals for their contributions to the discussion. Moderator: Tatsuya Aoki, Third Department of Surgery, Tokyo Medical University; commentators: Koji Yamaguchi, Department of Surgery, University of Occupational and Environmental Health; Koichi Aiura, Department of Surgery, Keio University School of Medicine; and Sohei Satoi, Department of Surgery, Kansai Medical University.

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Authors and Affiliations

  1. Department of Surgery, Kyoto University, 54 Shogoinkawaracho, Sakyoku, Kyoto, 606-8507, Japan

    Tatsuo Ito, Ryuichiro Doi, Morito Sakikubo, Kazuyuki Nagai, Atsushi Kida, Masayuki Koizumi, Toshihiko Masui, Yoshiya Kawaguchi & Shinji Uemoto

  2. Department of Diagnostic Pathology, Kyoto University, Kyoto, Japan

    Akihiko Yoshizawa & Toshiaki Manabe

  3. Department of Surgery, Japanese Red Cross Otsu Hospital, Otsu, Japan

    Ryuichiro Doi

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  1. Tatsuo Ito
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  2. Ryuichiro Doi
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Correspondence to Ryuichiro Doi.

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Ito, T., Doi, R., Yoshizawa, A. et al. The distribution of atypical epithelium in main-duct type intraductal papillary mucinous neoplasms of the pancreas. J Hepatobiliary Pancreat Sci 18, 241–249 (2011). https://doi.org/10.1007/s00534-010-0337-6

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  • DOI: https://doi.org/10.1007/s00534-010-0337-6

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