Abstract
Intraductal papillary mucinous neoplasms (IPMNs) are a group of exocrine mucin-producing tumors, diagnosed at a mean age of 60 years, with male prevalence.
Improvements in imaging techniques have led to an increasing incidental detection of IPMNs.
Age, clinical, laboratory and imaging findings are accurate in stratifying these lesions, and imaging plays a pivot role in their management.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Kim YH, Saini S, Sahani D et al (2005) Imaging diagnosis of cystic pancreatic lesions: pseudocyst versus nonpseudocyst. Radiographics 25(3):671–685
Manfredi R, Mehrabi S, Motton M et al (2008) MR imaging and MR cholangiopancreatography of multifocal intraductal papillary mucinous neoplasms of the side branches: MR pattern and its evolution. Radiol Med 113(3):414–428
Berland LL, Silverman SG, Gore RM et al (2010) Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol 7(10):754–773
Zhang XM, Mitchell DG, Dohke M et al (2002) Pancreatic cysts: depiction on single-shot fast spin-echo MR images. Radiology 223(2):547–553
Fernandez-del Castillo C, Targarona J, Thayer SP et al (2003) Incidental pancreatic cysts: clinicopathologic characteristics and comparison with symptomatic patients. Arch Surg 138(4):427–434
Lewin M, Hoeffel C, Azizi L et al (2008) Imaging of incidental cystic lesions of the pancreas. J Radiol 89(2):197–207
Fukukura Y, Fujiyoshi F, Sasaki M et al (2000) Intraductal papillary mucinous tumors of the pancreas: thin-section helical CT findings. AJR Am J Roentgenol 174(2):441–447
Manfredi R, Graziani R, Motton M et al (2009) Main pancreatic duct intraductal papillary mucinous neoplasms: accuracy of MR imaging in differentiation between benign and malignant tumors compared with histopathologic analysis. Radiology 253(1):106–115
Procacci C, Megibow AJ, Carbognin G et al (1999) Intraductal papillary mucinous tumor of the pancreas: a pictorial essay. Radiographics 19(6):1447–1463
Ishida M, Egawa S, Aoki T et al (2007) Characteristic clinicopathological features of the types of intraductal papillary-mucinous neoplasms of the pancreas. Pancreas 35(4):348–352
Schmidt CM, Yip-Schneider MT, Ralstin MC et al (2008) PGE(2) in pancreatic cyst fluid helps differentiate IPMN from MCN and predict IPMN dysplasia. J Gastrointest Surg 12(2):243–249
Pitman MB, Genevay M, Yaeger K et al (2010) High-grade atypical epithelial cells in pancreatic mucinous cysts are a more accurate predictor of malignancy than “positive” cytology. Cancer Cytopathol 118(6):434–440
Tanaka M, Fernandez-del Castillo C, Adsay V et al (2012) International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 12(3):183–197
Adsay NV, Fukushima N, Furukawa T et al (2010) Intraductal neoplasms of the pancreas. In: Bosman FT, Carneiro F, Hruban RH et al (eds) WHO classification of tumours of the digestive system, 4th edn. IARC, Lyon
Luttges J, Zamboni G, Longnecker D et al (2001) The immunohistochemical mucin expression pattern distinguishes different types of intraductal papillary mucinous neoplasms of the pancreas and determines their relationship to mucinous noncystic carcinoma and ductal adenocarcinoma. Am J Surg Pathol 25(7):942–948
Chadwick B, Willmore-Payne C, Tripp S et al (2009) Histologic, immunohistochemical, and molecular classification of 52 IPMNs of the pancreas. Appl Immunohistochem Mol Morphol 17(1):31–39
Mohri D, Asaoka Y, Ijichi H et al (2012) Different subtypes of intraductal papillary mucinous neoplasm in the pancreas have distinct pathways to pancreatic cancer progression. J Gastroenterol 47(2):203–213
Hruban RH, Pitman MB, Klimstra DS et al (2007) Tumors of the pancreas. In: American Registry of Pathology in collaboration with the Armed Forces Institute of Pathology. Washington, DC, XVIII, p 422. http://www.worldcat.org/title/tumors-of-the-pancreas/oclc/143399484
Zamboni G, Hirabayashi K, Castelli P et al (2013) Precancerous lesions of the pancreas. Best Pract Res Clin Gastroenterol 27(2):299–322
Adsay NV (2002) Intraductal papillary mucinous neoplasms of the pancreas: pathology and molecular genetics. J Gastrointest Surg 6(5):656–659
Adsay NV (2003) The “new kid on the block”: intraductal papillary mucinous neoplasms of the pancreas: current concepts and controversies. Surgery 133(5):459–463
Adsay NV, Merati K, Basturk O et al (2004) Pathologically and biologically distinct types of epithelium in intraductal papillary mucinous neoplasms: delineation of an “intestinal” pathway of carcinogenesis in the pancreas. Am J Surg Pathol 28(7):839–848
Furukawa T, Klöppel G, Volkan Adsay N et al (2005) Classification of types of intraductal papillary-mucinous neoplasm of the pancreas: a consensus study. Virchows Arch 447(5):794–799
Mino-Kenudson M, Fernández-del Castillo C, Baba Y et al (2011) Prognosis of invasive intraductal papillary mucinous neoplasm depends on histological and precursor epithelial subtypes. Gut 60(12):1712–1720
Sessa F, Solcia E, Capella C et al (1994) Intraductal papillary-mucinous tumours represent a distinct group of pancreatic neoplasms: an investigation of tumour cell differentiation and K-ras, p53 and c-erbB-2 abnormalities in 26 patients. Virchows Arch 425(4):357–367
Lim JH, Lee G, Oh YL (2001) Radiologic spectrum of intraductal papillary mucinous tumor of the pancreas. Radiographics 21(2):323–337
Pilleul F, Rochette A, Partensky C et al (2005) Preoperative evaluation of intraductal papillary mucinous tumors performed by pancreatic magnetic resonance imaging and correlated with surgical and histopathologic findings. J Magn Reson Imaging 21(3):237–244
Procacci C, Graziani R, Bicego E et al (1996) Intraductal mucin-producing tumors of the pancreas: imaging findings. Radiology 198(1):249–257
Campbell F, Azadeh B (2008) Cystic neoplasms of the exocrine pancreas. Histopathology 52(5):539–551
Adsay NV (2008) Cystic neoplasia of the pancreas: pathology and biology. J Gastrointest Surg 12(3):401–404
Perez-Johnston R, Narin O, Mino-Kenudson M et al (2013) Frequency and significance of calcification in IPMN. Pancreatology 13(1):43–47
Kang MJ, Jang JY, Kim SJ et al (2011) Cyst growth rate predicts malignancy in patients with branch duct intraductal papillary mucinous neoplasms. Clin Gastroenterol Hepatol 9(1):87–93
D’Onofrio M, Gallotti A, Pozzi Mucelli R (2010) Imaging techniques in pancreatic tumors. Expert Rev Med Devices 7(2):257–273
Martinez-Noguera A, D’Onofrio M (2007) Ultrasonography of the pancreas. 1. Conventional imaging. Abdom Imaging 32(2):136–149
Bennett GL, Hann LE (2001) Pancreatic ultrasonography. Surg Clin North Am 81(2):259–281
Hohl C, Schmidt T, Honnef D et al (2007) Ultrasonography of the pancreas. 2. Harmonic imaging. Abdom Imaging 32(2):150–160
Piscaglia F, Nolsoe C, Dietrich CF et al (2012) The EFSUMB Guidelines and Recommendations on the Clinical Practice of Contrast Enhanced Ultrasound (CEUS): update 2011 on non-hepatic applications. Ultraschall Med 33(1):33–59
Kurihara N, Kawamoto H, Kobayashi Y et al (2012) Vascular patterns in nodules of intraductal papillary mucinous neoplasms depicted under contrast-enhanced ultrasonography are helpful for evaluating malignant potential. Eur J Radiol 81(1):66–70
D’Onofrio M, Zamboni G, Malago R et al (2005) Pancreatic pathology. In: Quaia E (ed) Contrast media in ultrasonography. Springer, Berlin, pp 335–347
Itoh T, Hirooka Y, Itoh A et al (2005) Usefulness of contrast-enhanced transabdominal ultrasonography in the diagnosis of intraductal papillary mucinous tumors of the pancreas. Am J Gastroenterol 100(1):144–152
Sahani DV, Sainani NI, Blake MA et al (2011) Prospective evaluation of reader performance on MDCT in characterization of cystic pancreatic lesions and prediction of cyst biologic aggressiveness. AJR Am J Roentgenol 197(1):W53–W61
Sainani NI, Saokar A, Deshpande V et al (2009) Comparative performance of MDCT and MRI with MR cholangiopancreatography in characterizing small pancreatic cysts. AJR Am J Roentgenol 193(3):722–731
Shah AA, Sainani NI, Kambadakone AR et al (2009) Predictive value of multi-detector computed tomography for accurate diagnosis of serous cystadenoma: radiologic-pathologic correlation. World J Gastroenterol 15(22):2739–2747
Kawamoto S, Lawler LP, Horton KM et al (2006) MDCT of intraductal papillary mucinous neoplasm of the pancreas: evaluation of features predictive of invasive carcinoma. AJR Am J Roentgenol 186(3):687–695
Song SJ, Lee JM, Kim YJ et al (2007) Differentiation of intraductal papillary mucinous neoplasms from other pancreatic cystic masses: comparison of multirow-detector CT and MR imaging using ROC analysis. J Magn Reson Imaging 26(1):86–93
Sahani DV, Kadavigere R, Blake M et al (2006) Intraductal papillary mucinous neoplasm of pancreas: multi-detector row CT with 2D curved reformations–correlation with MRCP. Radiology 238(2):560–569
Sandrasegaran K, Lin C, Akisik FM et al (2010) State-of-the-art pancreatic MRI. AJR Am J Roentgenol 195(1):42–53
Kim JH, Eun HW, Park HJ et al (2012) Diagnostic performance of MRI and EUS in the differentiation of benign from malignant pancreatic cyst and cyst communication with the main duct. Eur J Radiol 81(11):2927–2935
Lee HJ, Kim MJ, Choi JY et al (2011) Relative accuracy of CT and MRI in the differentiation of benign from malignant pancreatic cystic lesions. Clin Radiol 66(4):315–321
Kartalis N, Lindholm TL, Aspelin P et al (2009) Diffusion-weighted magnetic resonance imaging of pancreas tumours. Eur Radiol 19(8):1981–1990
Pedrazzoli S, Sperti C, Pasquali C et al (2011) Comparison of International Consensus Guidelines versus 18-FDG PET in detecting malignancy of intraductal papillary mucinous neoplasms of the pancreas. Ann Surg 254(6):971–976
Hong HS, Yun M, Cho A et al (2010) The utility of F-18 FDG PET/CT in the evaluation of pancreatic intraductal papillary mucinous neoplasm. Clin Nucl Med 35(10):776–779
Takanami K, Hiraide T, Tsuda M et al (2011) Additional value of FDG PET/CT to contrast-enhanced CT in the differentiation between benign and malignant intraductal papillary mucinous neoplasms of the pancreas with mural nodules. Ann Nucl Med 25(7):501–510
Tomimaru Y, Takeda Y, Tatsumi M et al (2010) Utility of 2-[18 F] fluoro-2-deoxy-D-glucose positron emission tomography in differential diagnosis of benign and malignant intraductal papillary-mucinous neoplasm of the pancreas. Oncol Rep 24(3):613–620
Carlson SK, Johnson CD, Brandt KR et al (1998) Pancreatic cystic neoplasms: the role and sensitivity of needle aspiration and biopsy. Abdom Imaging 23(4):387–393
Pais SA, Attasaranya S, Leblanc JK et al (2007) Role of endoscopic ultrasound in the diagnosis of intraductal papillary mucinous neoplasms: correlation with surgical histopathology. Clin Gastroenterol Hepatol 5(4):489–495
Kubo H, Chijiiwa Y, Akahoshi K et al (2001) Intraductal papillary-mucinous tumors of the pancreas: differential diagnosis between benign and malignant tumors by endoscopic ultrasonography. Am J Gastroenterol 96(5):1429–1434
Nakagawa A, Yamaguchi T, Ohtsuka M et al (2009) Usefulness of multidetector computed tomography for detecting protruding lesions in intraductal papillary mucinous neoplasm of the pancreas in comparison with single-detector computed tomography and endoscopic ultrasonography. Pancreas 38(2):131–136
Hong SK, Loren DE, Rogart JN et al (2012) Targeted cyst wall puncture and aspiration during EUS-FNA increases the diagnostic yield of premalignant and malignant pancreatic cysts. Gastrointest Endosc 75(4):775–782
Rogart JN, Loren DE, Singu BS et al (2011) Cyst wall puncture and aspiration during EUS-guided fine needle aspiration may increase the diagnostic yield of mucinous cysts of the pancreas. J Clin Gastroenterol 45(2):164–169
Buscarini E, Pezzilli R, Cannizzaro R et al (2014) Italian consensus guidelines for the diagnostic work-up and follow-up of cystic pancreatic neoplasms. Dig Liver Dis 46(6):479–93
Yamaguchi K, Ohuchida J, Ohtsuka T et al (2002) Intraductal papillary-mucinous tumor of the pancreas concomitant with ductal carcinoma of the pancreas. Pancreatology 2(5):484–490
Yamaguchi K, Kanemitsu S, Hatori T et al (2011) Pancreatic ductal adenocarcinoma derived from IPMN and pancreatic ductal adenocarcinoma concomitant with IPMN. Pancreas 40(4):571–580
Yamaguchi K, Chijiiwa K, Shimizu S et al (1999) Intraductal papillary neoplasm of the pancreas: a clinical review of 13 benign and four malignant tumours. Eur J Surg 165(3):223–229
Calculli L, Pezzilli R, Brindisi C et al (2010) Pancreatic and extrapancreatic lesions in patients with intraductal papillary mucinous neoplasms of the pancreas: a single-centre experience. Radiol Med 115(3):442–452
Lee SY, Choi DW, Jang KT et al (2006) High expression of intestinal-type mucin (MUC2) in intraductal papillary mucinous neoplasms coexisting with extrapancreatic gastrointestinal cancers. Pancreas 32(2):186–189
Pugliese L, Del Chiaro M, D’Haese J et al (2013) Extrapancreatic neoplasms in patients with IPMN: is there an increased risk? JOP 14(5 Suppl):590
Yamada Y, Mori H, Hijiya N et al (2012) Intraductal papillary mucinous neoplasms of the pancreas complicated with intraductal hemorrhage, perforation, and fistula formation: CT and MR imaging findings with pathologic correlation. Abdom Imaging 37(1):100–109
Kurihara K, Nagai H, Kasahara K et al (2000) Biliopancreatic fistula associated with intraductal papillary-mucinous pancreatic cancer: institutional experience and review of the literature. Hepatogastroenterology 47(34):1164–1167
Koizumi M, Sata N, Yoshizawa K et al (2005) Post-ERCP pancreatogastric fistula associated with an intraductal papillary-mucinous neoplasm of the pancreas–a case report and literature review. World J Surg Oncol 3:70
Motosugi U, Yamaguchi H, Furukawa T et al (2012) Imaging studies of intraductal tutublopapillary neoplasms of the pancreas: 2-tone-duct sign and cork-of-wine-bottle sign as indicators of intraductal tumor growth. J Comput Assist Tomogr 36(6):710–717
Konigsrainer I, Glatzle J, Kloppel G et al (2008) Intraductal and cystic tubulopapillary adenocarcinoma of the pancreas-a possible variant of intraductal tubular carcinoma. Pancreas 36(1):92–95
Tajiri T, Tate G, Inagaki T et al (2005) Intraductal tubular neoplasms of the pancreas: histogenesis and differentiation. Pancreas 30(2):115–121
Tajiri T, Tate G, Kunimura T et al (2004) Histologic and immunohistochemical comparison of intraductal tubular carcinoma, intraductal papillary-mucinous carcinoma, and ductal adenocarcinoma of the pancreas. Pancreas 29(2):116–122
Kalaitzakis E, Braden B, Trivedi P et al (2009) Intraductal papillary mucinous neoplasm in chronic calcifying pancreatitis: egg or hen? World J Gastroenterol 15(10):1273–1275
Inan N, Arslan A, Akansel G et al (2008) Diffusion-weighted imaging in the differential diagnosis of cystic lesions of the pancreas. AJR Am J Roentgenol 191(4):1115–1121
Koito K, Namieno T, Ichimura T et al (1998) Mucin-producing pancreatic tumors: comparison of MR cholangiopancreatography with endoscopic retrograde cholangiopancreatography. Radiology 208(1):231–237
Kim JH, Hong SS, Kim YJ et al (2012) Intraductal papillary mucinous neoplasm of the pancreas: differentiate from chronic pancreatits by MR imaging. Eur J Radiol 81(4):671–676
Zhang XM, Shi H, Parker L et al (2003) Suspected early or mild chronic pancreatitis: enhancement patterns on gadolinium chelate dynamic MRI. J Magn Reson Imaging 17(1):86–94
Sahani DV, Kadavigere R, Saokar A et al (2005) Cystic pancreatic lesions: a simple imaging-based classification system for guiding management. Radiographics 25(6):1471–1484
Warshaw AL, Compton CC, Lewandrowski K et al (1990) Cystic tumors of the pancreas. New clinical, radiologic, and pathologic observations in 67 patients. Ann Surg 212(4):432–443
Kim SY, Lee JM, Kim SH et al (2006) Macrocystic neoplasms of the pancreas: CT differentiation of serous oligocystic adenoma from mucinous cystadenoma and intraductal papillary mucinous tumor. AJR Am J Roentgenol 187(5):1192–1198
Attasaranya S, Pais S, LeBlanc J et al (2007) Endoscopic ultrasound-guided fine needle aspiration and cyst fluid analysis for pancreatic cysts. JOP 8(5):553–563
Repak R, Rejchrt S, Bartova J et al (2009) Endoscopic ultrasonography (EUS) and EUS-guided fine-needle aspiration with cyst fluid analysis in pancreatic cystic neoplasms. Hepatogastroenterology 56(91–92):629–635
Albores-Saavedra J (2002) Acinar cystadenoma of the pancreas: a previously undescribed tumor. Ann Diagn Pathol 6(2):113–115
Zamboni G, Terris B, Scarpa A et al (2002) Acinar cell cystadenoma of the pancreas: a new entity? Am J Surg Pathol 26(6):698–704
Gumus M, Ugras S, Algin O et al (2011) Acinar cell cystadenoma (acinar cystic transformation) of the pancreas: the radiologic-pathologic features. Korean J Radiol 12(1):129–134
Khor TS, Badizadegan K, Ferrone C et al (2012) Acinar cystadenoma of the pancreas: a clinicopathologic study of 10 cases including multilocular lesions with mural nodules. Am J Surg Pathol 36(11):1579–1591
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer-Verlag Italia
About this chapter
Cite this chapter
Morana, G. et al. (2015). Intraductal Papillary Mucinous Neoplasm (IPMN). In: D'Onofrio, M., Capelli, P., Pederzoli, P. (eds) Imaging and Pathology of Pancreatic Neoplasms. Springer, Milano. https://doi.org/10.1007/978-88-470-5678-7_3
Download citation
DOI: https://doi.org/10.1007/978-88-470-5678-7_3
Published:
Publisher Name: Springer, Milano
Print ISBN: 978-88-470-5677-0
Online ISBN: 978-88-470-5678-7
eBook Packages: MedicineMedicine (R0)