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1.
Article in Chinese | WPRIM | ID: wpr-989258

ABSTRACT

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a cystic tumor of the pancreas with some malignant potential. According to the degree of pancreatic duct expansion and the location of the tumor, it can be divided into main-duct type, branch-duct type, and mixed type. According to the degree of atypia, it can be classified as low-grade dysplasia, high-grade dysplasia, or invasive IPMN. According to histological morphology and immunohistochemistry, there are four subtypes: gastric type, intestinal type, pancreaticobiliary type, and eosinophilic type. Ultrasound is commonly used in screening and follow-up, while CT, MRI/MRCP, and EUS can identify IPMN with high-risk and anxiety characteristics, which are valuable in determining the timing of surgery and patient status. Imaging omics is highly accurate in assessing the degree of dysplasia and can be used to identify people at high risk of malignant transformation. In this article, the clinical manifestations, pathology, and imaging features of IPMN are reviewed in the light of the relevant guidelines and literature in recent years, in order to deepen our understanding of IPMN and thus improve the accuracy of imaging diagnosis.

2.
Rev. argent. cir ; 113(1): 73-82, abr. 2021. graf
Article in Spanish | LILACS | ID: biblio-1288176

ABSTRACT

RESUMEN Antecedentes: Debido a la mejoría de los métodos diagnósticos, la incidencia de la neoplasia papilar mucinosa intraductal del páncreas (NPMI) ha aumentado en los últimos años. Objetivo: Presentar la experiencia en el manejo alejado de pacientes con NPMI en un centro de referencia. Material y métodos : Se realizó análisis retrospectivo de pacientes que consultaron al Servicio de Ci rugía General y HPB del Hospital Universitario Fundación Favaloro, por patología pancreática tumo ral entre enero de 2010 y diciembre de 2019. Los pacientes se clasificaron en 2 grupos: A) aquellos con diagnóstico en consultorio de NPMI y B) aquellos en los que la NPMI fue un hallazgo en la pieza quirúrgica (B). Resultados: Ochenta y seis pacientes fueron analizados: 79 (90%) se incluyeron en el grupo A y 7 en el grupo B. De los pacientes del grupo A, en 57 casos (66%) se decidió conducta expectante y seguimiento (AS). De los 22 pacientes restantes, 18 fueron operados (29%) (AC) y 4 tienen la cirugía pendiente. Para el grupo A, la supervivencia a los 5 años fue de 89% para el grupo AS, de 86% en grupo AC, y del 43% para el grupo B (Breslow 0,001, Log-Rank 0,001 vs. grupo A). Conclusión: El diagnóstico y manejo de la NPMI está hoy estandarizado, en las tipo I y III está indicada cirugía, la tipo II debe seguirse por riesgo de malignización; cuando se le indica cirugía, la supervivencia a largo plazo debe ser similar a la del grupo en seguimiento.


ABSTRACT Background: The incidence of intraductal papillary mucinous neoplasm (IPMN) of the pancreas has increased over the past years along with the development of diagnostic imaging tests. Objective: The aim of this study is to describe our experience on long-term management of patients with IPMNs in a reference center. Material and methods: We conducted a retrospective and descriptive analysis of patients with pancreatic neoplasms followed-up at the Department of General Surgery and Hepato-Biliary Surgery, Hospital Universitario Fundación Favaloro, between January 2010 and December 2019. The patients were classified into 2 groups: group A (diagnosis of IPMN made in the outpatient clinic), and group B (diagnosis of IPMN in the pathological examination). Results: Eighty-six patients were analyzed: 79 (90%) in group A and 7 in group B. In group A, a watchful waiting with monitoring (AM) was decided in 57 cases (66%). Of the remaining 22 patients, 18 (29%) patients underwent surgery (AS) and 4 are waiting for surgery. Survival at 5 years was 89% in group AM, 86% in group AS and 43% in group B (Breslow 0.001, log-rank test 0,001 vs. group A). Conclusion : The diagnosis and management of IPMNs is currently standardized. Surgery is indicated in MD-IPMN and mixed type IPMN. Patients with BD-IPMN type should be monitored due to the risk of malignant transformation. When surgery is indicated, long-term survival should be similar to that of the surveillance group.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Pancreatic Neoplasms , Pancreas , Pancreatic Intraductal Neoplasms , Neoplasms
3.
Article in Chinese | WPRIM | ID: wpr-912195

ABSTRACT

To evaluate the value of endoscopic retrograde cholangiopancreatography(ERCP)and SpyGlass in the diagnosis of intraductal papillary mucinous neoplasm of the bile duct (IPMN-B). Data of patients who underwent ERCP and SpyGlass in Hangzhou First People′s Hospital from January 2016 to December 2019 were analyzed. ERCP and SpyGlass features, complications, clinicopathologic characteristics and prognosis were retrospectively analyzed.A total of 9 patients (5 benign lesions and 4 malignant lesions) were included.ERCP was successfully performed in 9 cases, while SpyGlass was technically successful in 8 cases. Endoscopy showed mucus outflow from the papilla in 5 cases, and the mucus was removed by the balloon of ERCP in 8 cases.ERCP showed bile duct diffuse dilatation and filling defects in all patients. SpyGlass found the mucus in the bile duct in all patients. SpyGlass showed lesion mucosa were fish-egg like without vascular images (Ⅱtype, 3 cases), fish-egg like with vascular images (Ⅲ type, 1 case), villous (Ⅳtype, 4 cases). SpyGlass defined extent of the lesion in 8 cases. SpyGlass found that the lesion involved the intra and extrahepatic bile ducts in one case. Therefore, liver transplantation was recommended to avoid surgical exploration. One type Ⅲ lesion underwent a direct biopsy. The pathology showed moderate dysplasia, which was consistent with the postoperative pathology. No complication occurred. ERCP combined with SpyGlass could clarify the scope of IPMN-B and provide basis for surgical options, which is safe and effective in IPMN-B diagnosis.

4.
Article in Chinese | WPRIM | ID: wpr-931267

ABSTRACT

Objective:To investigate the MRI features of intraductal papillary mucinous tumor (IPMN) of the pancreas and establish a prediction model for predicting the malignancy risk.Methods:The clinical data of 260 IPMN patients who underwent MRI and pathological confirmed in the First Affiliated Hospital of Naval Medical University from October 2012 to April 2020 were retrospectively analyzed. According to the pathological results, all patients were divided into benign group (including IPMN with low-grade dysplasia) and malignant group (including IPMN with high grade dysplasia and invasive carcinoma). According to international consensus of prediction model modeling, patients were divided into training set and validation set in chronological order. A prediction model was developed based on a training set consisting of 193 patients (including 117 patients with benign IPMN and 76 patients with malignant IPMN) between October 2012 and April 2019, and the model was validated in 67 patients (including 40 patients with benign IPMN and 27 patients with malignant IPMN) between May 2019 and April 2020. The multivariable logistic regression model was adopted to identify the independent predictive factors for IPMN malignancy and establish and visualized a nomogram. The ROC was drawn and AUC was calculated. The decision curve analysis was used to evaluate its clinical usefulness.Results:The IPMN type, cyst size, thickened cyst wall, mural nodule size, diameter of main pancreatic duct (MPD) and the abrupt change in the caliber of the MPD with distal pancreatic atrophy in the training set and validation set, and jaundice and lymphadenopathy in the training set were significantly different between benign group and malignant group ( P<0.05). The multivariable logistic regression model of characteristics included the jaundice, cyst size, mural nodule size ≥5 mm, the abrupt change in caliber of the MPD with distal pancreatic atrophy were independent risk factors for IPMN maligancy. The model for predicting IPMN malignancy was -0.35+ 2.28×(jaundice)+ 1.57×(mural nodule size ≥5 mm)+ 2.92×(the abrupt change in caliber of the MPD with distal pancreatic atrophy)-1.95×(cyst <3 cm)-1.05×(cyst≥3 cm). The individualized prediction nomogram using these predictors of the malignant IPMN achieved an AUC of 0.85 (95% CI 0.79-0.91) in the training set and 0.84 (95% CI 0.74-0.94) in the validation set. The sensitivity, specificity and accuracy of the training set were 72.37%, 85.47% and 80.31%, respectively. The sensitivity, specificity and accuracy of the validation set were 81.48%, 75.00% and 77.61%, respectively. The decision curve analysis demonstrated that when the IPMN malignancy rate was >0.16, the nomogram diagnosing IPMN could benefit patients more than the strategy of considering all the patients as malignancy or non-malignancy. Conclusions:The nomogram based on MRI features can accurately predict the risk of malignant IPMN, and can be used as an effective predictive tool to provide more accurate information for personalized diagnosis and treatment of patients.

5.
Article in Chinese | WPRIM | ID: wpr-908470

ABSTRACT

The particularity of pancreatic anatomical location, the complexity of secretory function, and the diversity of pathology lead to complex imaging findings of pancreatic tumors. The common pancreatic tumors include pancreatic ductal adenocarcinoma, solid pseudopaillary neo-plasm, neuroendocrine neoplasm, intraductal papillary mucinous neoplasm, serous cystadenoma and mucinous cystic neoplasm. Atypical imaging findings are important reasons for misdiagnosis. Based on relevant clinical experiences, the authors analyze and summarize the atypical imaging findings of six kinds of common pancreatic tumors, aiming to improve radiologists and clinicians comprehensive understanding of pancreatic tumors.

6.
Chinese Journal of Radiology ; (12): 758-763, 2021.
Article in Chinese | WPRIM | ID: wpr-910237

ABSTRACT

Objective:To investigate the imaging features of colloid carcinoma arising from intraductal papillary mucinous neoplasm (IPMN) of pancreas and the differentiation features from ductal adenocarcinoma arising from IPMN, using the pathological findings as the reference.Methods:Twenty-four patients with pathologically confirmed colloid carcinoma from November 2013 to January 2020 in Changhai Hospital, Navy Medical University were included in this study. The clinical manifestations, imaging features and pathological data were retrospective reviewed. Thirty patients of ductal adenocarcinoma arising from IPMN confirmed by pathology were selected as the control group. CT and MRI features of two groups were blindly analyzed by two radiologists, including the lesions location, type of IPMN, size, components, density or signal, calcification, dilation and size of the main pancreatic duct (MPD), pancreatic parenchymal atrophy, fistula formation. The χ 2 test or Fisher exact probability was used to compare the imaging features between the two groups. Results:As for IPMN with colloid carcinoma, 16 cases were located in the head of the pancreas, 7 cases in the body and tail of the pancreas, and 1 case showed diffused changes of the pancreas. Mass was found in twenty-two cases, with the size of 54.5 (29) mm. Nineteen cases were solid-cystic, 4 were cystic and 1 was solid. Thick wall and internal separation with mild enhancement were displayed. Five cases were found with high signal on T 1WI. Thirteen cases had calcification and 2 cases had gas in the tumor. The size of MPD was (13±5) mm. Pancreatic parenchymal atrophy was found in 21 cases and fistula formation was found in 8 cases. The mass size of IPMN with colloid carcinoma was significantly greater than that of IPMN with ductal adenocarcinoma [31 (16) mm, Z=-3.758, P<0.001]. Solid-cystic mass was more found in IPMN with colloid carcinoma and solid mass was more found in IPMN with ductal adenocarcinoma ( P<0.001). Calcification ( P=0.001), fistula formation ( P=0.031), and high signal on T 1WI ( P=0.034) were more found in IPMN with colloid carcinoma than IPMN with ductal adenocarcinoma. Conclusion:Compared with IPMN with ductal adenocarcinoma, the solid-cystic mass, calcification, fistula formation and high signal on T 1WI were more commonly found in IPMN with colloid carcinoma.

7.
Article in Chinese | WPRIM | ID: wpr-910593

ABSTRACT

The intraductal papillary mucinous neoplasm (IPMN) become the focus of clinical study because of the potential malignancy. Based on the latest clinical guidelines and relevant literatures, this review summarized the epidemiologic features, pathological and histological features, pathogenesis, clinical manifestations, laboratory and radiology examination, therapy and follow-up to better understand the diagnosis and treatment for IPMN.

8.
Rev. gastroenterol. Perú ; 40(1): 52-60, ene.-mar 2020. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1144636

ABSTRACT

RESUMEN Introducción. La neoplasia mucinosa papilar intraductal (IPMN) se diagnostica ahora con mayor frecuencia debido al mayor uso de los métodos de imágenes, y conlleva un desafío clínico su manejo y seguimiento por su probable transformación maligna. Objetivos. Conocer las características por ecoendoscopía (USE), evolución clínica y sobrevida de los pacientes diagnosticados de IPMN por USE. Materiales y métodos. Estudio de cohorte retrospectivo con análisis de sobrevida en pacientes diagnosticados de IPMN por USE entre 2013 y 2018 en el Hospital Nacional Edgardo Rebagliati Martins (HNERM). Se analizaron variables demográficas y ecoendoscópicas, además de seguimiento hasta el fallecimiento o 6 meses después del término del estudio. Se realizó el análisis de sobrevida con los métodos de Kaplan-Meyer y de regresión de Cox. Resultados. Se incluyeron 133 pacientes con IPMN. Edad media fue 68,6 años, 80 (60,2%) fueron mujeres. Según subtipos, 89 (66,9%) fueron de rama secundaria, 23 (17,3%) de ducto principal y 21 (15,8%) de tipo mixto. La principal localización fue cabeza de páncreas (41,4%). En el seguimiento, 22 (16,5%) fueron a cirugía, 22 (16,5%) fallecieron después de una mediana de seguimiento de 522 días. En 8 pacientes (6%) se detectó neoplasia maligna. La tasa de sobrevida global fue 86.8% (IC 95%, 79,6-91,6) al año y de 81.9% (IC95%, 73,3-88,0) a los 3 años. En análisis univariado los factores asociados a la sobrevida fueron los subtipos de IPMN-DP (p=0,02) y mixto (p=0,005), sexo masculino (p=0,004), tamaño de lesión ≥30 mm (p=0,000), nódulos (p=0,014) y Wirsung ≥10 mm (p=0,01). En el análisis multivariado, los factores predictores asociados con la sobrevida fueron: IPMN-DP (HR=6,3, p=0,005), IPMN mixto (HR=4,9, p=0,008) y tamaño de lesión ≥30 mm (HR=7,1, p=0,000). Conclusiones. El diagnostico de IPMN de ducto principal y mixto se asocian como factores predictores de sobrevida, al igual que el tamaño de la lesión ≥30 mm.


ABSTRACT Introduction: Intraductal papillary mucinous neoplasms (IPMN) are diagnosed more frequently because the higher use of radiologic exams, in that sense they are a great challenge to define its management and treatment in relation to its potential malignant transformation. Objective: To describe IPMN clinical profile, endoscopic ultrasound (EUS) characteristics and survival in all patients diagnosed with IPMN by EUS at HNERM. Materials and methods: Retrospective cohort of patients with IPMN diagnosed at HNERM by EUS from 2013 to 2018. Descriptive statistics was used for clinical profile and EUS characteristics. Kaplan Meir Method and Cox regression analysis was applied for survival analysis. Results: 133 patients with IPMN were included. Medium age was 68.6 years, 80 (60.2%) were female. According to IPMN subtypes, 89 (66.9%) originated from secondary branch, 23 (17.3%) from main duct (MD) and 21 (15.8%) were mixed type (MT). Head of pancreas was the main localization (41.4%). In follow-up, 22 (16.5%) were derived to surgery. Mortality occurred in 16.5% (22 cases) after a median follow-up of 522 days. Malignant transformation was diagnosed in 6% (8 cases). Survival was 86.8% (IC 95%, 79.6-91.6) at 1 year and 81.9% (IC95%, 73.3-88.0) at 3 years. Univariate analysis demonstrated that factors associated to survival were MD-IPMN (p=0.02) y MT-IPMN (p=0.005), male gender (p=004), nodule size ≥30 mm (p=0.000), presence of nodules (p=0.014) and Wirsung ≥10 mm (p=0.01). Multivariate analysis showed that predictive factors for survival were MD-IPMN (HR=6.3, p=0.005), MT-IPMN (HR=4.9, p=0.008) and nodule size ≥30 mm (HR=7.1, p=0.000). Conclusions: Diagnosis of MD-IPMN and MT-IPMN are predictive factors for survival as well as nodule size ≥ 30mm.

9.
Clinical Endoscopy ; : 588-597, 2019.
Article in English | WPRIM | ID: wpr-785665

ABSTRACT

BACKGROUND/AIMS: In this study, we aimed to evaluate the predictive value of localized stenosis of the main pancreatic duct (MPD) for early detection of pancreatic cancer.METHODS: Among 689 patients who underwent endoscopic retrograde pancreatography from January 2008 to September 2018, 19 patients with MPD findings were enrolled. These patients showed findings for indicating suspicious pancreatic cancer at an early stage (FiCE); FiCE was defined as a single, localized stenosis in the MPD without a detectable mass (using any other imaging methods) and without other pancreatic diseases, such as definite chronic pancreatitis, intraductal papillary mucinous neoplasm, and autoimmune pancreatitis. Final diagnoses were established by examining resected specimens or through follow-up examinations after an interval of >5 years.RESULTS: Among 19 patients with FiCE, 11 underwent surgical resection and 8 were evaluated after a >5-year observation period. The final diagnosis of the MPD stenosis was judged to be pancreatic cancer in 9 patients (47%), including 3 with intraepithelial cancer, and to be a non-neoplastic change in 10. The sensitivity, specificity, and accuracy of preoperative pancreatic juice cytology were 75%, 100%, and 88%, respectively.CONCLUSIONS: The predictive value of FiCE for pancreatic cancer prevalence was 47%. Histological confirmation with pancreatic juice cytology is necessary before surgical resection.


Subject(s)
Humans , Cholangiopancreatography, Endoscopic Retrograde , Constriction, Pathologic , Diagnosis , Follow-Up Studies , Mucins , Pancreatic Diseases , Pancreatic Ducts , Pancreatic Juice , Pancreatic Neoplasms , Pancreatitis , Pancreatitis, Chronic , Prevalence , Sensitivity and Specificity
10.
Article in English | WPRIM | ID: wpr-786348

ABSTRACT

The increasing discovery of pancreatic cystic neoplasm is a recent trend because of the widespread use and development of imaging techniques. Physicians have to recognize the different characteristics of the cystic neoplasms so that a determination may be selected regarding the potential for malignancy. Appropriate evaluation of pancreatic cystic lesion includes a multidisciplinary approach involving gastroenterologists with experience in endoscopic ultrasound, radiologist, and pancreatic surgeons. The selective approach is important in management of this neoplasm with minimizing incorrect diagnosis and unnecessary surgery. Considering the characteristic features of pancreatic cystic neoplasm, the clinical decision should be tailored according to needs and conditions of the individual patients.


Subject(s)
Humans , Diagnosis , Follow-Up Studies , Pancreatic Cyst , Surgeons , Ultrasonography , Unnecessary Procedures
11.
Gut and Liver ; : 617-627, 2019.
Article in English | WPRIM | ID: wpr-763888

ABSTRACT

Intraductal papillary neoplasms of the bile duct (IPNBs) are known to show various pathologic features and biological behaviors. Recently, two categories of IPNBs have been proposed based on their histologic similarities to pancreatic intraductal papillary mucinous neoplasms (IPMNs): type 1 IPNBs, which share many features with IPMNs; and type 2 IPNBs, which are variably different from IPMNs. The four IPNB subtypes were re-evaluated with respect to these two categories. Intestinal IPNBs showing a predominantly villous growth may correspond to type 1, while those showing papillay-tubular or papillay-villous growth correspond to type 2. Regarding gastric IPNB, those with regular foveolar structures with varying numbers of pyloric glands may correspond to type 1, while those with papillary-foveolar structures with gastric immunophenotypes and complicated structures may correspond to type 2. Pancreatobiliary IPNBs that show fine ramifying branching may be categorized as type 1, while others containing many complicated structures may be categorized as type 2. Oncocytic type, which displays solid growth or irregular papillary structures, may correspond to type 2, while papillary configurations with pseudostratified oncocytic lining cells correspond to type 1. Generally, type 1 IPNBs of any subtype develop in the intrahepatic bile ducts, while type 2 IPNBs develop in the extrahepatic bile duct. These findings suggest that IPNBs arising in the intrahepatic ducts are biliary counterparts of IPMNs, while those arising in the extrahepatic ducts display differences from prototypical IPMNs. The recognition of these two categories of IPNBs with reference to IPMNs and their anatomical location along the biliary tree may deepen our understanding of IPNBs.


Subject(s)
Bile Ducts , Bile Ducts, Extrahepatic , Bile Ducts, Intrahepatic , Bile , Biliary Tract , Cholangiocarcinoma , Gastric Mucosa , Mucins
12.
Article in English | WPRIM | ID: wpr-780704

ABSTRACT

@#Intraductal papillary mucinous neoplasm (IPMN) is a rare pancreatic neoplasm. The presentation varies from recurrent pancreatitis, steatorrhea and weight loss to incidental findings during imaging studies. The recognition of IPMN is crucial in deciding for prompt surgical intervention, which is the best treatment modality for this precancerous condition. Here, we report a case of 55-year-old man with massive upper gastro intestinal bleeding arising from a huge fungating duodenal mass. In view of massive bleeding, a decision for emergency Whipple's pancreaticoduodenectomy was made. Final histological diagnosis confirmed as IPMN. To the best of our knowledge, this is the first case of IPMN presented with a huge fungating duodenal mass causing massive UGIB requiring surgical intervention.

13.
Article in Chinese | WPRIM | ID: wpr-699179

ABSTRACT

With the popularization of the aging population and imaging examination,detection rate of the pancreatic cystic neoplasm are increasing in recent years,which commonly includes intraductal papillary mucinous neoplasm (IPMN),mucinous cystic neoplasm (MCN),serous cystic neoplasm (SCN) and solid pesudopapillary tumor (SPT).The differential diagnosis is essential to decide surgical resection or observation.The diagnosis of pancreatic cystic tumor relies primarily on imaging examination.For patients who need to long-term follow-up,the MRI should be recommended.The preoperative precision diagnosis that is performed by traditional imaging,tumor markers,endoscopic ultrasonography and contribute to make the individualized therapy plan.The follow-up strategy is optimal for majority of patients with SCN.According to patients' condition,the surgical resection or observation will be selected for patients with IPMN or MCN after finding malignant transformation-related high risk factors.SPT has been classified as the malignant tumor,and if patients are suspected to have SPT by imaging examination,surgical resection should be recommended.

14.
Article in Chinese | WPRIM | ID: wpr-838205

ABSTRACT

Pancreatic cysts have many histological subtypes. With development of imaging techniques such as computed tomography and magnetic resonance imaging, detection rate of pancreatic cysts has been increasing. And standardized diagnosis and treatment of pancreatic cysts remains a clinical challenge. Due to insufficient understanding of imaging features and tumor markers of pancreatic cysts, a reasonable procedure of diagnosis and treatment has not been published so far. Several guidelines for the diagnosis and treatment of pancreatic cysts with high impact have been published, including international consensus guidelines, European experts consensus statement and American Gastroenterological Association guidelines. This review focused on the diagnosis and treatment strategies and suggestions proposed by the above guidelines, and application of endoscopic ultrasonography, so as to provid references for treatment of pancreatic cysts.

15.
Article in Chinese | WPRIM | ID: wpr-506044

ABSTRACT

Objective To study the clinical features of intraductal papillary mucinous neoplasm of the biliary tract (BT-IPMN) and to analyse the diagnostic and surgical patterns.Method The data of 19 patients with BT-IPMN admitted from Jun.2012 to Jul.2016 were retrospectively analyzed.Results These 19 (2.3%) patients with BT-IPMN came from 815 patients with biliary tract tumors who were treated in our institution.There were 9 males and 10 females.The male to female ratio was 1.0∶ 1.1.The mean age was 60.6 ± 12.9 years with a range from 25 to 78 years.Jaundice (in 10 patients) and abdominal discomfort (in 6 patients) were the most common presenting symptoms.Bile duct dilatation and intraluminal mass were typical preoperative imaging findings.All these 19 patients were diagnosed to have BT-IPMN histopathologically.18 patients underwent surgery in our hospital.Left lateral hepatic sectionectomy or left hepatectomy was performed in 8 patients,pancreaticoduodenectomy in 6,local excision of bile duct and cholangiojejunostomy in 3 and central hepatectomy in 1.The average operating time was 280 minutes and the average amount of intra-operative bleeding was 515 ml.Fourteen patients underwent regional lymph node dissection and 3 positive lymph nodes were detected out of 94 resected lymph nodes.Sixteen patients were followed up from 1 to 51 months with a mean of (25.7 ± 19.5) months.Fourteen of these patients were still surviving.Two patients died 3 and 17 months after operation due to the tumor.Conclusions Intraductal papillary mucinous neoplasm of the biliary tract was very rare.Early diagnosis was not easy.There was a low percentage of lymphatic metastasis.Surgery was the first choice of treatment and complete resection of BT-IPMN was associated with good long-term survival.

16.
Article in Chinese | WPRIM | ID: wpr-607249

ABSTRACT

Intraductal papillary mucinous neoplasm (IPMN) is a kind of epithelial neoplasms of mucin-producing cells arising in the main duct and/or branch ducts of the pancreas,and it is one of the precancerous lesions of the pancreatic cancer.With the development of pathology and radiology,the diagnostic rate of IPMN has been gradually increased and given a new understanding on the pathological characteristics,clinical diagnosis and treatment of IPMN.This review overviewed the classification,diagnosis,management and prognosis of IPMN,aiming to deepen the understanding of IPMN and improve the level of diagnosis and treatment.

17.
Chinese Journal of Ultrasonography ; (12): 1039-1042, 2017.
Article in Chinese | WPRIM | ID: wpr-707607

ABSTRACT

Objective To explore the ultrasound characteristics of intraductal papillary mucinous neoplasm of the bile duct( IPM N-B) and evaluate its diagnostic value . Methods Seventeen cases of IPM N-B were diagnosed by ultrasonic examination and confirmed by surgery and pathology . The ultrasound findings and distribution of color Doppler flow signals were observed and analyzed in comparison with the surgical and pathological results . Results Ultrasound revealed the characteristics of IPMN-B:① Bile duct mural nodules that looked like papillary or polypoid were observed; ② Asymmetry bile duct dilatation ,namely obvious dilatation in the lesion intrahepatic bile duct ,but only mild dilatation in the normal intrahepatic bile duct ;③Typical lesions showed mucus in bile duct along bile duct wall without acoustic shadow or move . High frequency ultrasound revealed that mucus in bile duct could float that looked like gelatin when operator vibrated probe in those superficial lesions . This is reliable characteristics of IPMN-B by ultrasound . Conclusions Ultrasound is of high value in the diagnosis of IPMN-B .

18.
Article in Chinese | WPRIM | ID: wpr-711473

ABSTRACT

Objective To evaluate the potential malignancy, prognosis and risk factors for intraductal papillary mucinous neoplasm(IPMN), which were classified into different risk levels based on Fukuoka guideline. Methods A retrospective analysis of patients with IPMN diagnosed at Nanjing Drum Tower Hospital from 2009 to 2016 was conducted. Clinical characteristics,treatment and prognosis of IPMNs were analyzed. Results A total of 94 IPMN patients were included and divided into 3 groups according to Fukuoka guideline,46 patients in high-risk(HR)group,30 in group of worrisome features(WF), and 18 in low-risk(LR)group. For patients undergoing surgery treatment, there were 5 cases(19.2%,5/26)in HR group and 2 cases(12.5%,2/16)in WF group whose postoperative pathological findings were malignant (P=0.690). The 5-year survival rates after operations were 73.9% and 77.0% in HR and WF group, respectively(P=0.830). For patients without surgery treatment, in a 5-year follow-up, there were 6 cases (33.3%,6/18),2 cases(16.7%,2/12)and 0(0.0%,0/18)progressing into pancreatic cancers in HR, WF and LR groups,respectively(P<0.05). In addition,among the three groups,the 5-year survival rates were 49.5%,85.7% and 100.0%(P=0.025). Jaundice was significantly related to prognosis(P<0.01) and the hazard ratio was 8.883(95%CI:2.953-26.721). Conclusion Jaundice is a predictive risk factor for survival of IPMN. As for the treatment to IPMN, patients in HR group should receive surgery treatment while those in LR group can be followed up. For patients in WF group,the treatment should be customized, with evaluation of predictive risk factors,and operations can be performed when needed.

19.
Article in English | WPRIM | ID: wpr-121115

ABSTRACT

Preoperative cross-sectional imaging, such as computed tomography and magnetic resonance imaging, plays a key role in differentiating between benign and malignant intraductal papillary mucinous neoplasms. This article reviews the imaging features associated with malignant intraductal papillary mucinous neoplasm, as well as the recent studies validating the 2012 international consensus guidelines. This review also compared the diagnostic performance of computed tomography and magnetic resonance imaging in differentiating malignant from benign intraductal papillary mucinous neoplasms.


Subject(s)
Consensus , Magnetic Resonance Imaging , Mucins , Pancreas
20.
Article in English | WPRIM | ID: wpr-184918

ABSTRACT

Endoscopic ultrasound (EUS), with or without fine needle aspiration (FNA), has become an essential tool in the evaluation of pancreatobiliary diseases. Although conventional EUS is superior to multidetector computed tomography in tumor detection and staging, there are situations when characterization of various pancreatobiliary lesions remains difficult. Contrast-enhanced EUS (CE EUS) can further improve the detection and characterization of pancreatic solid lesions such as ductal adenocarcinoma, neuroendocrine tumor, or mass-forming autoimmune pancreatitis based on differences in the enhancement pattern of the target lesions. It is also useful in differentiating between mural nodules and mucous clots in pancreatic cystic neoplasms, and characterizing various lesions in the gallbladder and bile duct. CE EUS is complementary to FNA and has the potential to increase the diagnostic yield on the first FNA needle pass.


Subject(s)
Adenocarcinoma , Bile Ducts , Biopsy, Fine-Needle , Gallbladder , Multidetector Computed Tomography , Needles , Neuroendocrine Tumors , Pancreatic Cyst , Pancreatitis , Ultrasonography
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