Intraductal neoplasms of the pancreas

doi:10.1016/S0002-9610(98)00039-7

The American Journal of Surgery

Volume 175, Issue 5, May 1998, Pages 426-432

https://doi.org/10.1016/S0002-9610(98)00039-7 Get rights and content

background

Since 1980 a group of pancreatic tumors have been termed intraductal papillary mucinous tumors (IPMT). Because these tumors occupy an intraductal position they are demonstrated by pancreatography to reside in the main pancreatic duct (MPD) or side branch ducts (SBD). Lesions of IPMT result in abdominal pain or pancreatitis symptoms because mucin production or papillary growth results in ductal obstruction. Only 104 cases had been reported in the literature by 1996 but more are being presented in abstract form. We reviewed our own 33 cases to assist defining operative decision-making criteria.

methods

All cases of IPMT between 1989 and 1997 were reviewed for clinical presentation, anatomy by endoscopic retrograde cholangiopancreatography and computed tomography, histologic findings, and long-term outcomes.

results

Our cases were older (65 years) and presented with disease centered mainly in the head of the gland. Clinical presentation was epigastric pain (82%), pancreatitis (56%), weight loss (36%), diabetes (27%), and jaundice (9%). Operations were pancreatectomy in 31 (Whipple n = 15, total n = 5, distal n = 10, local n = 1), bypass only (n = 1), and no operation (n = 1). Malignancy was found in 14 of 33 (42%). Factors significantly associated (P <0.05 Fisher exact test) with malignancy were history of alcohol abuse or death from disease. Jaundice or presence in both MPD and SBD approached a significant association with malignancy but not abdominal pain, weight loss, diabetes, preoperative serum elevations of amylase, SGOT, CA-19-9, or CEA; diffuse MPD dilation, gland region, gross mucus in ducts or filling defects, cytology, calcifications, or a pancreatic mass. In 31 resected patients after a follow-up of 37 months (1 to 103) death had occurred in 6 of 13 malignant cases and 0 of 18 with benign disease. Three-year actuarial survival was 82% (all) and 36% (malignant). Symptom recurrence after resection was found in 6 of 31 at a mean of 13 months postoperatively and was associated with death from disease (P <0.05) or presence of pain preoperatively.

conclusion

Malignancy is common with IPMT and is more likely to be present with the clinical history of alcohol abuse or jaundice and if the tumor involves both the MPD and the SBD. The prognosis after resection is better than pancreatic cancer but the 19% recurrence of symptoms was equally seen with benign or malignant cases owing to residual disease in pancreatic remnants. The amount of resection should be extensive in patients likely to have malignancy (alcohol, jaundice, MPD + SBD). In those likely to redevelop symptoms, ie, those with preoperative pain, a careful assessment should be made via imaging studies for extent of disease.

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Citation Excerpt :
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View full text

Intraductal neoplasms of the pancreas

background

methods

results

conclusion

Gastroenterology

Histological Typing ofTumors of the Pancreas

ERCP and imaging diagnosis of pancreatic cancer

Gastroenterolog Endosc.

Four cases of “mucin-producing” cancer of the pancreas on specific findings of the papilla of Vater

Cystic tumors of the pancreas: new clinical, radiological, and pathological observations in 67 patients

Ann Surg.

Mucin-producing neoplasms of the pancreas: intraductal papillary and mucinous cystic neoplasms

Ann Surg.

Cystic tumors of the pancreas

Surg Clin North Am.

Intraductal papillary mucinous neoplasms of the pancreas associated with so-called “mucinous ductal ectasia”

Am J Surg Path.