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home - Pancreas - Pancreatic Masses and Cysts - IPMN Written by Dr Sebastian Zeki

IPMN

Intraductal papillary mucinous neoplasm= =IPMT/ IPMN Mucin Histological Features:Dilated ductal segments with mucous secreting cells.It is usually within the head of the pancreas and progresses distally.It is localised or diffuse .If involves mall branch ducts = BDT-IPMN, if main duct= MDT-IPMN. IPMN Cancer Adenoma to carcinoma sequence- 10 to 15 years High malignant potential. PrognosisThere is a 70 % 3-year survival overall for IPMN with a cancer.Patients with BDT-IPMN do better than those with MDT-IPMN. Features Suggesting malignancy:A main pancreatic duct >10 mm.Cystic lesion >30 mm with irregular, thick septum.Mural nodules >10 mm. MDT-IPMN (75%)Start in head and progress distallyMore aggressive BDT-IPMNStart in uncinate/ tail.Less likely to be malignant TreatmentResect if suspicious features for malignancy. Histological Subtypes:Intestinal-type IPMN-more show moderate or high-grade dysplasia.Main ducts>side branches.Gastric-type IPMN- typically show no > low grade dysplasia.Side branches >main duct.Pancreatobiliary-type IPMN-show high grade dysplasia and are considered to have high malignant potential.Oncocytic type IPMN-typically exhibit high grade dysplasia.Tubular type IPMN - rare and are usually low grade. Endoscopic retrograde cholangiopancreatogra-phy (ERCP) Filling defectsFish-eye papilla with mucus extruding from the orifice.Endoscopic ultrasound (EUS)Segmental or diffuse dilation of the main pancreatic duct with the presence of intraductal (mural) nodules in MDT-IPMNMultiple small cysts (5 to 20 mm) in BDT-IPMNCan be helpful to distinguish from chronic pancreatitisPancreatoscopy Intraductal ultrasound —For tumour extent in MDT-IPMNCT scan and magnetic resonance imaging A CT scan finding of >3 mm mural nodules within a cyst or the duct is highly suggestive of malignancy MRP is better than ERCP but not at looking at peripheral ducts. Aetiology And Pathogenesis-K-ras mutations are found in 50%.-P53 overexpression occurs late in IPMN during the progression to cancer.-DPC4 (deleted in pancreatic cancer) is expressed in all cases of IPMN vs 50% inactivation in traditional pancreatic ductal cancer.-MUC2 mucin and MUC5 mucin mRNA are highly expressed in IPMN. Clinical PresentationIt presents at 60-70 years.Previous acute panc or chronic obstruc-tive pancreatitis is a risk.CA 19-9 and CEA are usually normal. (in order of frequency) Diagnosis Written by Dr Sebastian Zeki

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