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Wang SF, Wu CH, Sung KF, Tsou YK, Lin CH, Lee MH, Liu NJ. The Distribution and Predictive Factor of Extra-Pancreatic Malignancy Occurrence in Patients with Pancreatic Intraductal Papillary Mucinous Neoplasm-A Ten-Year Follow-Up Case-Control Study in Taiwan. Cancers (Basel) 2024; 16:4102. [PMID: 39682288 PMCID: PMC11640256 DOI: 10.3390/cancers16234102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Revised: 11/29/2024] [Accepted: 12/03/2024] [Indexed: 12/18/2024] Open
Abstract
BACKGROUND AND AIMS A higher incidence of extra-pancreatic malignancies (EPMs) in patients with pancreatic intraductal papillary mucinous neoplasm (IPMN) than in the general population has been shown in several studies. We suppose that EPMs also occur after IPMN has been diagnosed, but few reports have discussed the risk factors that have been identified, except for old age, which was only noted in one study. Our study aims to recognize the distribution of EPMs in Taiwanese patients with a longer duration of follow-up and investigate the risk factors to predict EPMs in IPMN patients. METHODS We retrospectively analyzed 114 patients with pancreatic IPMN from 1 January 2010 to 31 December 2014 in Chang Gung Memorial Hospital. The characteristics of the patients were all recorded. Different EPMs are demonstrated as occurring before, concurrently with, or after IPMN diagnosis. The risk factors were compared between patients with or without an EPM. RESULTS After an average follow-up duration of 10.45 years, 47 EPMs occurred in 42 patients (36.8%), and over half were found after IPMN was diagnosed (55.3%). The most common EPMs were colon cancer and lung cancer (21.3%). Moreover, cyst size progression was highly associated with EPM occurrence (p = 0.004) and predictive of EPM occurrence after IPMN (p = 0.002), with a cut-off value of 1 cm (accuracy: 79%; sensitivity: 88%; specificity: 58%). CONCLUSIONS Colon cancer and lung cancer account for the majority EPMs in Taiwan. EPMs were also frequently found after IPMN diagnosis when the follow-up duration was prolonged up to 10.45 years. Cyst size progression is a risk factor of EPM after IPMN diagnosis and we suggest a cut-off value of 1 cm for clinical utility.
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Affiliation(s)
- Sheng-Fu Wang
- Department of Gastroenterology and Hepatology, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan; (S.-F.W.); (C.-H.W.); (Y.-K.T.); (C.-H.L.); (M.-H.L.); (N.-J.L.)
- School of Medicine, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan
| | - Chi-Huan Wu
- Department of Gastroenterology and Hepatology, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan; (S.-F.W.); (C.-H.W.); (Y.-K.T.); (C.-H.L.); (M.-H.L.); (N.-J.L.)
- School of Medicine, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan
| | - Kai-Feng Sung
- Department of Gastroenterology and Hepatology, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan; (S.-F.W.); (C.-H.W.); (Y.-K.T.); (C.-H.L.); (M.-H.L.); (N.-J.L.)
- School of Medicine, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan
| | - Yung-Kuan Tsou
- Department of Gastroenterology and Hepatology, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan; (S.-F.W.); (C.-H.W.); (Y.-K.T.); (C.-H.L.); (M.-H.L.); (N.-J.L.)
- School of Medicine, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan
| | - Cheng-Hui Lin
- Department of Gastroenterology and Hepatology, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan; (S.-F.W.); (C.-H.W.); (Y.-K.T.); (C.-H.L.); (M.-H.L.); (N.-J.L.)
- School of Medicine, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan
| | - Mu-Hsien Lee
- Department of Gastroenterology and Hepatology, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan; (S.-F.W.); (C.-H.W.); (Y.-K.T.); (C.-H.L.); (M.-H.L.); (N.-J.L.)
- School of Medicine, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan
| | - Nai-Jen Liu
- Department of Gastroenterology and Hepatology, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan; (S.-F.W.); (C.-H.W.); (Y.-K.T.); (C.-H.L.); (M.-H.L.); (N.-J.L.)
- School of Medicine, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan
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Zelnik Yovel D, Santo E, Khader M, Tzadok R, Bar N, Aizic A, Shibolet O, Ben-Ami Shor D. Esophagogastroduodenal Findings in Patients with Intraductal Papillary Mucinous Neoplasms. Diagnostics (Basel) 2023; 13:2127. [PMID: 37371022 DOI: 10.3390/diagnostics13122127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023] Open
Abstract
The association between intraductal papillary mucinous neoplasms (IPMNs) and extra-pancreatic malignancies is controversial. This cross-sectional study compared esophagogastroduodenal findings in 340 IPMN patients to those of age- and gender-matched controls without known IPMNs who underwent esophagogastroduodenoscopies (EGDs) for similar clinical reasons. The presence of gastric and esophageal cancer, Barrett's esophagus, neuroendocrine tumors (NETs), gastrointestinal stromal tumors (GISTs), gastric adenomas, and ampullary tumors was assessed. The results showed that 4/340 (1.2%) of the IPMN patients had gastric cancer and 1/340 (0.3%) had esophageal cancer. The matched control group had a similar incidence of gastric cancer (5/340) (1.5%), with no esophageal cancer cases (p > 0.999). The overall incidence of other esophagogastroduodenal conditions did not significantly differ between the IPMN patients and the controls. However, the incidence of gastric cancer in the IPMN patients was higher than expected based on national cancer registry data (standardized incidence ratio of 31.39; p < 0.001; CI 8.38-78.76). In conclusion, IPMN patients have a significantly higher incidence of gastric cancer compared to the general population. However, the incidence of esophagogastroduodenal findings, including gastric and esophageal cancer, is similar between IPMN patients and those who undergo an EGD for similar clinical indications. Further research is needed to determine optimal surveillance strategies for IPMN patients regarding their risk of developing gastric cancer.
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Affiliation(s)
- Dana Zelnik Yovel
- The Kamila Gonczarowski Institute of Gastroenterology and Liver Diseases, Shamir (Assaf Harofeh) Medical Center, Zerifin 703000, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Erwin Santo
- Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Majd Khader
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Roie Tzadok
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
- Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Nir Bar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
- Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Asaf Aizic
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
- Department of Pathology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Oren Shibolet
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
- Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Dana Ben-Ami Shor
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
- Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
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A meta-analysis: incidental intraductal papillary mucinous neoplasm and extra-pancreatic malignancy. Langenbecks Arch Surg 2021; 407:451-458. [PMID: 34664122 DOI: 10.1007/s00423-021-02355-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 10/06/2021] [Indexed: 12/09/2022]
Abstract
INTRODUCTION Meta-analysis aimed to quantify the relationship between intraductal papillary mucinous neoplasm (IPMN) and increased incidence of extra-pancreatic malignancy (EPM) previously reported in qualitative observational cohort studies. METHODS Study protocol was registered with PROSPERO (CRD42020169614) and conducted to the Meta-analysis Of Observational Studies in Epidemiology and systematic review reported with Preferred Reporting Items for Systematic Reviews and Meta-Analyses, Assessing the Methodological Quality of Systematic Reviews guidelines. RESULTS Sixteen studies (total of 8240 patients) were included in the pooled, and 7399 patients in the subgroup meta-analyses. The odds ratio (OR) for any EPM in the presence of IPMN was 57.9 (95% confidence interval 40.5-82.7), fixed effects, I2 = 59% (p < 0.0014). Subgroup analysis for any gastrointestinal EPM (i.e. oesophagus, stomach, colon and rectum) in the presence of an IPMN estimated an overall OR of 12.9 (95% confidence interval 8.8-19.0), fixed effects, I2 = 64% (p < 0.0004). CONCLUSION Patients with an IPMN are categorically at increased risk for a higher incidence of EPM and particularly the odds of a gastrointestinal malignancy are also increased in comparison with the general population. We advocate that patients presenting with an IPMN should be considered for gastrointestinal screening including colonoscopy, upper gastrointestinal endoscopy or computed tomography.
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Ma YH, Yamaguchi T, Yasumura T, Kuno T, Kobayashi S, Yoshida T, Ishida T, Ishida Y, Takaoka S, Fan JL, Enomoto N. Pancreatic cancer secondary to intraductal papillary mucinous neoplasm with collision between gastric cancer and B-cell lymphoma: A case report. World J Clin Cases 2021; 9:2400-2408. [PMID: 33869620 PMCID: PMC8026844 DOI: 10.12998/wjcc.v9.i10.2400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/16/2021] [Accepted: 02/09/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with intraductal papillary mucinous neoplasm (IPMN) have an increased risk of pancreatic and extrapancreatic malignancies. Lymphomas are rare extrapancreatic malignancies, and in situ collisions of early gastric cancer and diffuse large B-cell lymphoma (DLBCL) are even rarer. Here, we report the first case of pancreatic cancer comorbid with in situ collision of extrapancreatic malignancies (early gastric cancer and DLBCL) in a follow-up IPMN patient. Furthermore, we have made innovations in the treatment of such cases.
CASE SUMMARY An 81-year-old Japanese female diagnosed with IPMN developed elevated carbohydrate antigen (CA) 19-9 levels during follow-up. Because her CA19-9 levels continued to rise, endoscopic ultrasound (EUS) was performed and revealed a suspicious lesion at the pancreatic tail. However, lesions in the pancreas were not found by computed tomography, magnetic resonance imaging, or endoscopic retrograde cholangiopancreatography. To make an exact patho-logical diagnosis, EUS-guided fine needle aspiration was performed. To our supprise, early gastric cancer was found in preoperative gastroscopy. The gastric cancer was completely resected through endoscopic submucosal dissection before postoperative pathology identified early adenocarcinoma collided with DLBCL. Subsequent EUS-guided fine needle aspiration provided pathological support for the pancreatic cancer diagnosis, and then laparoscopic distal pancreatectomy and splenectomy were performed. CA19-9 levels returned to normal postoperatively.
CONCLUSION Endoscopic submucosal dissection is appropriate for submucosal lymphomas in patients intoleratant of chemotherapy. EUS can detect small IPMN-related pancreatic tumors.
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Affiliation(s)
- Yu-Hong Ma
- Department of Gastroenterology, Ningxia Hui Autonomous Region People’s Hospital, Yinchuan 750021, Ningxia Hui Autonomous Region, China
| | - Tatsuya Yamaguchi
- Department of the First Internal Medicine, Faculty of Medicine, University of Yamanashi, Chuo 409-3898, Yamanashi, Japan
| | - Tomoki Yasumura
- Department of the First Internal Medicine, Faculty of Medicine, University of Yamanashi, Chuo 409-3898, Yamanashi, Japan
| | - Toru Kuno
- Department of the First Internal Medicine, Faculty of Medicine, University of Yamanashi, Chuo 409-3898, Yamanashi, Japan
| | - Shoji Kobayashi
- Department of the First Internal Medicine, Faculty of Medicine, University of Yamanashi, Chuo 409-3898, Yamanashi, Japan
| | - Takashi Yoshida
- Department of the First Internal Medicine, Faculty of Medicine, University of Yamanashi, Chuo 409-3898, Yamanashi, Japan
| | - Takeshi Ishida
- Department of the First Internal Medicine, Faculty of Medicine, University of Yamanashi, Chuo 409-3898, Yamanashi, Japan
| | - Yasuaki Ishida
- Department of the First Internal Medicine, Faculty of Medicine, University of Yamanashi, Chuo 409-3898, Yamanashi, Japan
| | - Shinya Takaoka
- Department of the First Internal Medicine, Faculty of Medicine, University of Yamanashi, Chuo 409-3898, Yamanashi, Japan
| | - Jiang-Lin Fan
- Department of Molecular Pathology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo 409-3898, Yamanashi, Japan
| | - Nobuyuki Enomoto
- Department of the First Internal Medicine, Faculty of Medicine, University of Yamanashi, Chuo 409-3898, Yamanashi, Japan
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Halder PJ, Sharma S, S N. A left-sided cystic pancreatic incidentaloma with sigmoid colon adenocarcinoma: a case report. J Med Case Rep 2018; 12:251. [PMID: 30157943 PMCID: PMC6116566 DOI: 10.1186/s13256-018-1778-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 07/24/2018] [Indexed: 12/02/2022] Open
Abstract
Background The synchronous colorectal malignancy is well described in the literature but combination of pancreatic incidentaloma with sigmoid cancer has not been well described and the association has not been described in syndrome. Case presentation A 65-year-old man from the Indian subcontinent with a history of abdominal pain with loss of appetite, and with a history of bleeding per rectum and altered bowel habits presented to our hospital. An abdominal examination revealed a palpable mass in the region of his epigastrium and left hypochondrium, and a rectal examination was normal. A work-up included blood investigations, an abdominal contrast-enhanced computed tomography scan, a colonoscopy, and a positron emission tomography/computed tomography scan. He was managed by simultaneous distal pancreaticosplenectomy and radical sigmoidectomy. The final histopathology results were suggestive of moderately differentiated adenocarcinoma of the sigmoid colon with serous cystadenoma of the pancreas. Conclusions The synchronous sigmoid colon cancer and pancreatic cystic incidentaloma is a rare presentation, which, to the best of our knowledge, has not been reported in the literature. We report the surgical management of this case and present a review of the literature. Genetic studies may be conducted to find out whether there is common genetic mutation resulting in these two malignancies, and may be helpful in screening programs.
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Affiliation(s)
- P J Halder
- Department of Surgical Gastroenterology and HPB Surgery, Jagjivan Ram Hospital, Maratha Mandir Lane, Mumbai Central, Mumbai, 400008, India
| | - Swapnil Sharma
- DNB Surgical Gastroenterology, Jagjivan Ram Hospital, Mumbai, 400008, India
| | - Nikhil S
- Department of Surgical Gastroenterology and HPB Surgery, Jagjivan Ram Hospital, Maratha Mandir Lane, Mumbai Central, Mumbai, 400008, India. .,DNB Surgical Gastroenterology, Jagjivan Ram Hospital, Mumbai, 400008, India.
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Panic N, Macchini F, Solito S, Boccia S, Leoncini E, Larghi A, Berretti D, Pevere S, Vadala S, Marino M, Zilli M, Bulajic M. Prevalence of Extrapancreatic Malignancies Among Patients With Intraductal Papillary Mucinous Neoplasms of the Pancreas. Pancreas 2018; 47:721-724. [PMID: 29771766 DOI: 10.1097/mpa.0000000000001072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES We conducted a study in order to assess the prevalence of extrapancreatic malignancies (EPMs) in a cohort of patients with intraductal papillary mucinous neoplasms (IPMNs) from northeastern Italy. METHODS A study was conducted in hospital Santa Maria della Misericordia, Udine, Italy. Hospital records were screened in order to identify newly diagnosed IPMN cases in the period from January 1, 2009, to December 31, 2015. We searched for EPMs diagnosed previous to, synchronous to, or after the IPMN. The ratio of the observed (O) number of patients with EPMs to the expected (E) was calculated. RESULTS We identified 72 EPMs in 63 (31.8%) of 198 patients included. Among them, 51 (70.8%) were diagnosed previous to, 17 (23.6%) synchronous to, and 4 (5.6%) after the IPMN. Most frequently diagnosed were colorectal (12 patients [6.1%]), breast (8 patients [6.8%, in females]), renal cell (8 patients [4.0%]), and prostate cancer (7 patients [8.6%, in males]). The O/E ratios for EPMs were significantly increased for cancer in general (3.66; 95% confidence interval [CI], 2.39-5.37), renal cell (9.62; 95% CI, 1.98-28.10), prostate (4.91; 95% CI, 1.59-11.45), and breast cancer (3.16; 95% CI, 1.03-7.37). CONCLUSIONS We report an increased risk of EPMs in patients with IPMN, especially for renal cell, prostate, colorectal, and breast cancer.
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Affiliation(s)
| | - Federico Macchini
- Department for Gastroenterology and Digestive Endoscopy, Academic Center of Udine, Udine
| | - Sonia Solito
- Department for Gastroenterology and Digestive Endoscopy, Academic Center of Udine, Udine
| | - Stefania Boccia
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, IRCCS Fondazione Policlinico "Agostino Gemelli"
| | - Emanuele Leoncini
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, IRCCS Fondazione Policlinico "Agostino Gemelli"
| | - Alberto Larghi
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | - Debora Berretti
- Department for Gastroenterology and Digestive Endoscopy, Academic Center of Udine, Udine
| | - Sara Pevere
- Department for Gastroenterology and Digestive Endoscopy, Academic Center of Udine, Udine
| | - Salvatore Vadala
- Department for Gastroenterology and Digestive Endoscopy, Academic Center of Udine, Udine
| | - Marco Marino
- Department for Gastroenterology and Digestive Endoscopy, Academic Center of Udine, Udine
| | - Maurizio Zilli
- Department for Gastroenterology and Digestive Endoscopy, Academic Center of Udine, Udine
| | - Milutin Bulajic
- Department for Gastroenterology and Digestive Endoscopy, Academic Center of Udine, Udine
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Baiocchi GL, Molfino S, Frittoli B, Pigozzi G, Gheza F, Gaverini G, Tarasconi A, Ricci C, Bertagna F, Grazioli L, Tiberio GAM, Portolani N. Increased risk of second malignancy in pancreatic intraductal papillary mucinous tumors: Review of the literature. World J Gastroenterol 2015; 21:7313-7319. [PMID: 26109820 PMCID: PMC4476895 DOI: 10.3748/wjg.v21.i23.7313] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 04/12/2015] [Accepted: 05/07/2015] [Indexed: 02/06/2023] Open
Abstract
AIM To analyze the available evidence about the risk of extrapancreatic malignancies and pancreatic ductal adenocarcinoma associated to pancreatic intraductal papillary mucinous tumors (IPMNs). METHODS A systematic search of literature was undertaken using MEDLINE, EMBASE, Cochrane and Web-of-Science libraries. No limitations for year of publication were considered; preference was given to English papers. All references in selected articles were further screened for additional publications. Both clinical series and Literature reviews were selected. For all eligible studies, a standard data extraction form was filled in and the following data were extracted: study design, number of patients, prevalence of pancreatic cancer and extrapancreatic malignancies in IPMN patients and control groups, if available. RESULTS A total of 805 abstracts were selected and read; 25 articles were considered pertinent and 17 were chosen for the present systematic review. Eleven monocentric series, 1 multicentric series, 1 case-control study, 1 population-based study and 3 case report were included. A total of 2881 patients were globally analyzed as study group, and the incidence of pancreatic cancer and/or extrapancreatic malignancies ranged from 5% to 52%, with a mean of 28.71%. When a control group was analyzed (6 papers), the same incidence was as low as 9.4%. CONCLUSION The available Literature is unanimous in claiming IPMNs to be strongly associated with pancreatic and extrapancreatic malignancies. The consequences in IPMNs management are herein discussed.
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MESH Headings
- Carcinoma, Pancreatic Ductal/epidemiology
- Carcinoma, Pancreatic Ductal/pathology
- Humans
- Incidence
- Neoplasms, Cystic, Mucinous, and Serous/epidemiology
- Neoplasms, Cystic, Mucinous, and Serous/pathology
- Neoplasms, Second Primary/epidemiology
- Neoplasms, Second Primary/pathology
- Pancreatic Neoplasms/epidemiology
- Pancreatic Neoplasms/pathology
- Pancreatic Neoplasms/therapy
- Prevalence
- Prognosis
- Risk Assessment
- Risk Factors
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Tanaka M, Fernández-del Castillo C, Adsay V, Chari S, Falconi M, Jang JY, Kimura W, Levy P, Pitman MB, Schmidt CM, Shimizu M, Wolfgang CL, Yamaguchi K, Yamao K. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 2012; 12:183-97. [PMID: 22687371 DOI: 10.1016/j.pan.2012.04.004] [Citation(s) in RCA: 1609] [Impact Index Per Article: 123.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 04/06/2012] [Accepted: 04/08/2012] [Indexed: 12/11/2022]
Abstract
The international consensus guidelines for management of intraductal papillary mucinous neoplasm and mucinous cystic neoplasm of the pancreas established in 2006 have increased awareness and improved the management of these entities. During the subsequent 5 years, a considerable amount of information has been added to the literature. Based on a consensus symposium held during the 14th meeting of the International Association of Pancreatology in Fukuoka, Japan, in 2010, the working group has generated new guidelines. Since the levels of evidence for all items addressed in these guidelines are low, being 4 or 5, we still have to designate them "consensus", rather than "evidence-based", guidelines. To simplify the entire guidelines, we have adopted a statement format that differs from the 2006 guidelines, although the headings are similar to the previous guidelines, i.e., classification, investigation, indications for and methods of resection and other treatments, histological aspects, and methods of follow-up. The present guidelines include recent information and recommendations based on our current understanding, and highlight issues that remain controversial and areas where further research is required.
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Affiliation(s)
- Masao Tanaka
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
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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.
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Khan S, Sclabas G, Reid-Lombardo KM. Population-based epidemiology, risk factors and screening of intraductal papillary mucinous neoplasm patients. World J Gastrointest Surg 2010; 2:314-8. [PMID: 21160836 PMCID: PMC2999209 DOI: 10.4240/wjgs.v2.i10.314] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 09/16/2010] [Accepted: 09/23/2010] [Indexed: 02/06/2023] Open
Abstract
Intraductal papillary mucinous neoplasm (IPMN) was first recognized in the 1980s with increasing publications over the last decade as the incidence increased sharply, especially at tertiary-care referral centers. Population-based studies have estimated the age and sex-adjusted cumulative incidence of IPMN to be 2.04 per 100 000 person-years (95% confidence interval: 1.28-2.80). It is now understood that IPMN can be classified anywhere along the spectrum of the adenoma to carcinoma sequence and often harbors mutations in genes such as KRAS early in the disease process. Many patients are diagnosed incidentally after imaging of the abdomen for other diagnostic purposes. Patients that present with a history of symptoms such as pancreatitis and abdominal pain are at high risk of harboring a malignancy. Clinicopathologic features such as involvement of the main pancreatic duct, presence of mural nodules, and side branch disease > 3.0 cm in size may indicate that there is an underlying invasive component to the IPMN. In addition, the incidence of extra-pancreatic neoplasms is higher in patients with IPMN, with reported rates of 25% to 50%. There are no current screening recommendations to detect and diagnose IPMN but once the diagnosis is made, screening for extrapancreatic neoplasms such as colon polyps and colorectal cancer should be considered. Surgical resection is the recommend treatment for patients with high-risk features while close observation can be offered to patients without worrisome signs and symptoms of carcinoma.
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Affiliation(s)
- Saboor Khan
- Saboor Khan, Guido Sclabas, Kaye M Reid-Lombardo, Division of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, MN 55905, United States
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Benarroch-Gampel J, Riall TS. Extrapancreatic malignancies and intraductal papillary mucinous neoplasms of the pancreas. World J Gastrointest Surg 2010; 2:363-7. [PMID: 21160845 PMCID: PMC2999205 DOI: 10.4240/wjgs.v2.i10.363] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 09/14/2010] [Accepted: 09/21/2010] [Indexed: 02/06/2023] Open
Abstract
Over the last two decades multiple studies have demonstrated an increased incidence of additional malignancies in patients with intraductal papillary mucinous neoplasms (IPMNs). Additional malignancies have been identified in 10%-52% of patients with IPMNs. The majority of these additional cancers occur before or concurrent with the diagnosis of IPMN. The gastrointestinal tract is most commonly involved in secondary malignancies, with benign colon polyps and colon cancer commonly seen in western countries and gastric cancer commonly seen in Asian countries. Other extrapancreatic malignancies associated with IPMNs include benign and malignant esophageal neoplasms, gastrointestinal stromal tumors, carcinoid tumors, hepatobiliary cancers, breast cancers, prostate cancers, and lung cancers. There is no clear etiology for the development of secondary malignancies in patients with IPMN. Although population-based studies have shown different results from single institution studies regarding the exact incidence of additional primary cancers in IPMN patients, both have reached the same conclusion: there is a higher incidence of extrapancreatic malignancies in patients with IPMNs than in the general population. This finding has significant clinical implications for both the initial evaluation and the subsequent long-term follow-up of patients with IPMNs. If a patient has not had recent colonoscopy, this should be performed during the evaluation of a newly diagnosed IPMN. Upper endoscopy should be performed in patients from Asian countries or for those who present with symptoms suggestive of upper gastrointestinal disease. Routine screening studies (breast and prostate) should be carried out as currently recommended for patient’s age both before and after the diagnosis of IPMN.
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Affiliation(s)
- Jaime Benarroch-Gampel
- Jaime Benarroch-Gampel, Taylor S Riall, Department of Surgery, The University of Texas Medical Branch, Galveston, TX 77555-0541, United States
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Yoon WJ, Ryu JK. [How can we interpret the high prevalence of extrapancreatic neoplasms in patients with intraductal papillary mucinous neoplasm of the pancreas?]. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2009; 54:417-419. [PMID: 20052811 DOI: 10.4166/kjg.2009.54.6.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Kim HG. [Meaning of incidence of extrapancreatic neoplasms in patients with intraductal papillary mucinous neoplasms of pancreas]. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2009; 54:196-198. [PMID: 19844158 DOI: 10.4166/kjg.2009.54.3.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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