Clinical Study of Intraductal Papillary Mucinous Tumor of the Pancreas

ABSTRACT

PURPOSE: Intraductal papillary mucinous tumor (IPMT) of the pancreas pathologically shows papillary proliferation and its tumor cells display a spectrum of changes ranging from adenoma to infiltrating carcinoma. Because of this variability, there have been many difficulties for making an accurate diagnosis and administering proper treatment. The aim of this study was to determine the treatment strategy and differential diagnosis of benign and malignant IPMT. METHODS: Between January 2000 and June 2007, 24 patients with IPMT of the pancreas underwent surgery. The relationships among the clinopathologic features and tumor locations and subtypes were retrospectively investigated. In addition, the type of surgical procedures and findings, the microscopic finding, the immunohistochemical staining and the clinopathological features were analyzed. RESULTS: There were 17 men and 7 women with a mean age of 65 (range 45~81). Pathologically, 11 cases were benign, 9 were borderline and 4 were malignant. The tumor was located in the head of the pancreas in 17 patients. 16 cases received Whipple's procedure and pylorus preserving pancreaticoduodenectomy, and the others were received different kinds of operations. Regarding the subtypes of IPMT, 2 cases were the main duct type, 19 were the branched type and 3 were the combined type. There were no statistically significant differences in the clinical manifestations, radiologic findings and immnohistochemical staining between the patients with benign and malignant IPMT. Except two patients who were not followed up, all the patients had no recurrence and they survived. CONCLUSION: It is very difficult to exactly differentiate malignant IPMT from benign IPMT with using the current preoperative evaluations and immunohistochemical staining of the resected specimens. The patients who were operated on and followed in our hospital had no recurrence and they all survived. Therefore, if IPMT is suspected, we think the patients should be operated on and we should continue studying other specific antibodies for immunohistochemical staining.