Diagnosis and treatment of 45 patients with pancreas intraductal papillary mucinous neoplasm_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

SUN Mingbing ¹ , CHEN Wei ² , LUAN Lipeng ¹ , ZHANG Zhe ¹ , LI Dechun ¹ , ZHAO Xin ¹ ,  CHEN Xiaojuan ¹

1. Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P. R. China;
2. Department of Imaging, The Children’s Hospital of Soochow University, Suzhou, Jiangsu 215003, P. R. China;

Corresponding author：

CHEN Xiaojuan, Email: chenxj@suda.edu.cn

Keywords：

intraductal papillary mucinous neoplasm; pancreas; diagnosis; therapy

DOI：

10.7507/1007-9424.201905019

Video：

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Objective To summarize clinical features, imaging findings, and pathological characteristics of pancreas intraductal papillary mucinous neoplasm (IPMN) and to improve effect of clinical diagnosis and treatment of pancreas IPMN.Method The clinical data of 45 patients with pancreas IPMN who underwent surgical resection from February 2014 to February 2019 in the First Affiliated Hospital of Soochow University were retrospectively analyzed.Results Of the 45 patients with pancreas IPMN, 28 patients were male and 17 patients were female, aged from 44 to 81 years old with (65±21) years old. There were 35 patients with age > 60 years old. The most common clinical manifestation was the upper abdominal discomfort (26 patients) and the lesions mainly occurred in the head of pancreas (20 patients). Twenty-four (58.5%, 24/41) patients and 17 (81.0%, 17/21) patients were definitely diagnosed by the CT and MRI, respectively. Twenty-five patients underwent the pancreaticoduodenectomy, 5 patients underwent the partial pancreatectomy, 2 patient underwent the pancreatic tumor resection, 12 patients underwent the pancreatic body and tail resection, 1 patient underwent the total pancreatectomy. The pathological findings showed that 15 cases were mild dysplasia, 5 cases were moderate dysplasia, 3 cases were severe dysplasia. Six cases invaded the pancreas and its surrounding adipose tissue, 5 cases invaded the tissue outside the pancreas. After the discharge, 28/32 patients were followed up for 3 to 24 months. Among all the followed-up patients, the 1-year survival rate was 100% (28/28) and the 2-year survival rate was 96.4% (27/28). The patients underwent the CT examination on the 3rd, 6th, 12th,18th, and 24th month, no lymph node metastasis was found.Conclusions Pancreas IPMN is more common in the elderly, mainly manifests as gastrointestinal symptoms, such as upper abdominal discomfort, etc. Surgery is its main treatment mean. Preoperative diagnosis mainly depends on CT examination and MRI examination, but positive rate of MRI examination is higher. Postoperative pathological section shows different degree of dysplasia.

Citation： SUN Mingbing, CHEN Wei, LUAN Lipeng, ZHANG Zhe, LI Dechun, ZHAO Xin, CHEN Xiaojuan. Diagnosis and treatment of 45 patients with pancreas intraductal papillary mucinous neoplasm. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(10): 1184-1188. doi: 10.7507/1007-9424.201905019 Copy

1.	HLongnecker DS, Adsay NV, Fernandez-del Castillo C, et al. Histopathological diagnosis of pancreatic intraepithelial neoplasia and intraductal papillary-mucinous neoplasms: interobserver agreement. Pancreas, 2005, 31(4): 344-349.
2.	Sohn TA, Yeo CJ, Cameron JL, et al. Intraductal papillary mucinous neoplasms of the pancreas: an increasingly recognized clinicopathologic entity. Ann Surg, 2001, 234(3): 313-322.
3.	Tanaka M, Chari S, Adsay V, et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology, 2006, 6(1-2): 17-32.
4.	Tanaka M, Fernández-del Castillo C, Adsay V, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology, 2012, 12(3): 183-917.
5.	Sakorafas GH, Smyrniotis V, Reid-Lombardo KM, et al. Primary pancreatic cystic neoplasms revisited. Part Ⅲ. Intraductal papillary mucinous neoplasms. Surg Oncol, 2011, 20(2): e109-e118.
6.	Baba T, Yamaguchi T, Ishihara T, et al. Distinguishing benign from malignant intraductal papillary mucinous tumors of the pancreas by imaging techniques. Pancreas, 2004, 29(3): 212-217.
7.	Konstantinou F, Syrigos KN, Saif MW. Intraductal papillary mucinous neoplasms of the pancreas (IPMNs): epidemiology, diagnosis and future aspects. JOP, 2013, 14(2): 141-144.
8.	Furukawa T, Hatori T, Fujita I, et al. Prognostic relevance of morphological types of intraductal papillary mucinous neoplasms of the pancreas. Gut, 2011, 60(4): 509-516.
9.	Shimizu Y, Yamaue H, Maguchi H, et al. Predictors of malignancy in intraductal papillary mucinous neoplasm of the pancreas: analysis of 310 pancreatic resection patients at multiple high-volume centers. Pancreas, 2013, 42(5): 883-888.
10.	Lafemina J, Katabi N, Klimstra D, et al. Malignant progression in IPMN: a cohort analysis of patients initially selected for resection or observation. Ann Surg Oncol, 2013, 20(2): 440-447.
11.	Swartz MJ, Hsu CC, Pawlik TM, et al. Adjuvant chemoradiotherapy after pancreatic resection for invasive carcinoma associated with intraductal papillary mucinous neoplasm of the pancreas. Int J Radiat Oncol Biol Phys, 2010, 76(3): 839-844.
12.	Hruban RH, Adsay NV, Albores-Saavedra J, et al. Pancreatic intraepithelial neoplasia: a new nomenclature and classification system for pancreatic duct lesions. Am J Surg Pathol, 2001, 25(5): 579-586.
13.	谢欢, 印隆林, 苟文枭, 等. 胰腺少见肿瘤的 CT 及 MRI 诊断 (附 34 例报道). 中国普外基础与临床杂志, 2017, 24(1): 107-114.
14.	Jiang XT, Tao HQ, Zou SC. Detection of serum tumor markers in the diagnosis and treatment of patients with pancreatic cancer. Hepatobiliary Pancreat Dis Int, 2004, 3(3): 464-468.
15.	华宇明, 倪泉兴, 傅德良, 等. 胰腺癌血清肿瘤标记物的表达及其临床意义. 中国普外基础与临床杂志, 2001, 8(6): 387-389.
16.	张伟, 耿小平. 胰腺导管内乳头状粘液瘤诊治新进展. 肝胆外科杂志, 2014, 22(1): 68-72.
17.	Longnecker DS, Adler G, Hruban RH, et al. Intraductal papillary mucinous neoplasms of the pancreas//Hamilton SR, AaltonenLA, eds. WHO classification of tumors of the digestive system. Lyon: IARC Press, 2000: 237-240.
18.	Cellier C, Cuillerier E, Palazzo L, et al. Intraductal papillary and mucinous tumors of the pancreas: accuracy of preoperative computed tomography, endoscopic retrograde pancreatography and endoscopic ultrasonography, and long-term outcome in a large surgical series. Gastrointest Endosc, 1998, 47(1): 42-49.
19.	邹波. 胰腺导管内乳头状粘液瘤的诊断和外科治疗. 肝胆外科杂志, 2009, 17(2): 110-113.
20.	汪秀玲, 程丽, 徐凯, 等. 胰腺导管内乳头状黏液性肿瘤的 MRI 诊断. 临床放射学杂志, 2009, 28(1): 63-65.
21.	Seki M, Ninomiya E, Aruga A, et al. Image-diagnostic features of mature cystic teratomas of the pancreas: report on two cases difficult to diagnose preoperatively. J Hepatobiliary Pancreat Surg, 2005, 12(4): 336-340.
22.	侯建芳, 丁伟, 孙卫国. 胰腺导管内乳头状黏液性肿瘤的诊断与治疗. 肝胆胰外科杂志, 2018, 30(2): 167-169.
23.	钟井松, 胡春洪, 沈海林. 良、恶性胰腺导管内乳头状黏液性肿瘤 CT 特征与病理联系. 临床放射学杂志, 2015, 34(1): 66-69.
24.	Rodriguez JR, Salvia R, Crippa S, et al. Branch-duct intraductal papillary mucinous neoplasms: observations in 145 patients who underwent resection. Gastroenterology, 2007, 133(1): 72-79.
25.	Sohn TA, Yeo CJ, Cameron JL, et al. Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Ann Surg, 2004, 239(6): 788-797.

1. HLongnecker DS, Adsay NV, Fernandez-del Castillo C, et al. Histopathological diagnosis of pancreatic intraepithelial neoplasia and intraductal papillary-mucinous neoplasms: interobserver agreement. Pancreas, 2005, 31(4): 344-349.
2. Sohn TA, Yeo CJ, Cameron JL, et al. Intraductal papillary mucinous neoplasms of the pancreas: an increasingly recognized clinicopathologic entity. Ann Surg, 2001, 234(3): 313-322.
3. Tanaka M, Chari S, Adsay V, et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology, 2006, 6(1-2): 17-32.
4. Tanaka M, Fernández-del Castillo C, Adsay V, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology, 2012, 12(3): 183-917.
5. Sakorafas GH, Smyrniotis V, Reid-Lombardo KM, et al. Primary pancreatic cystic neoplasms revisited. Part Ⅲ. Intraductal papillary mucinous neoplasms. Surg Oncol, 2011, 20(2): e109-e118.
6. Baba T, Yamaguchi T, Ishihara T, et al. Distinguishing benign from malignant intraductal papillary mucinous tumors of the pancreas by imaging techniques. Pancreas, 2004, 29(3): 212-217.
7. Konstantinou F, Syrigos KN, Saif MW. Intraductal papillary mucinous neoplasms of the pancreas (IPMNs): epidemiology, diagnosis and future aspects. JOP, 2013, 14(2): 141-144.
8. Furukawa T, Hatori T, Fujita I, et al. Prognostic relevance of morphological types of intraductal papillary mucinous neoplasms of the pancreas. Gut, 2011, 60(4): 509-516.
9. Shimizu Y, Yamaue H, Maguchi H, et al. Predictors of malignancy in intraductal papillary mucinous neoplasm of the pancreas: analysis of 310 pancreatic resection patients at multiple high-volume centers. Pancreas, 2013, 42(5): 883-888.
10. Lafemina J, Katabi N, Klimstra D, et al. Malignant progression in IPMN: a cohort analysis of patients initially selected for resection or observation. Ann Surg Oncol, 2013, 20(2): 440-447.
11. Swartz MJ, Hsu CC, Pawlik TM, et al. Adjuvant chemoradiotherapy after pancreatic resection for invasive carcinoma associated with intraductal papillary mucinous neoplasm of the pancreas. Int J Radiat Oncol Biol Phys, 2010, 76(3): 839-844.
12. Hruban RH, Adsay NV, Albores-Saavedra J, et al. Pancreatic intraepithelial neoplasia: a new nomenclature and classification system for pancreatic duct lesions. Am J Surg Pathol, 2001, 25(5): 579-586.
13. 谢欢, 印隆林, 苟文枭, 等. 胰腺少见肿瘤的 CT 及 MRI 诊断 (附 34 例报道). 中国普外基础与临床杂志, 2017, 24(1): 107-114.
14. Jiang XT, Tao HQ, Zou SC. Detection of serum tumor markers in the diagnosis and treatment of patients with pancreatic cancer. Hepatobiliary Pancreat Dis Int, 2004, 3(3): 464-468.
15. 华宇明, 倪泉兴, 傅德良, 等. 胰腺癌血清肿瘤标记物的表达及其临床意义. 中国普外基础与临床杂志, 2001, 8(6): 387-389.
16. 张伟, 耿小平. 胰腺导管内乳头状粘液瘤诊治新进展. 肝胆外科杂志, 2014, 22(1): 68-72.
17. Longnecker DS, Adler G, Hruban RH, et al. Intraductal papillary mucinous neoplasms of the pancreas//Hamilton SR, AaltonenLA, eds. WHO classification of tumors of the digestive system. Lyon: IARC Press, 2000: 237-240.
18. Cellier C, Cuillerier E, Palazzo L, et al. Intraductal papillary and mucinous tumors of the pancreas: accuracy of preoperative computed tomography, endoscopic retrograde pancreatography and endoscopic ultrasonography, and long-term outcome in a large surgical series. Gastrointest Endosc, 1998, 47(1): 42-49.
19. 邹波. 胰腺导管内乳头状粘液瘤的诊断和外科治疗. 肝胆外科杂志, 2009, 17(2): 110-113.
20. 汪秀玲, 程丽, 徐凯, 等. 胰腺导管内乳头状黏液性肿瘤的 MRI 诊断. 临床放射学杂志, 2009, 28(1): 63-65.
21. Seki M, Ninomiya E, Aruga A, et al. Image-diagnostic features of mature cystic teratomas of the pancreas: report on two cases difficult to diagnose preoperatively. J Hepatobiliary Pancreat Surg, 2005, 12(4): 336-340.
22. 侯建芳, 丁伟, 孙卫国. 胰腺导管内乳头状黏液性肿瘤的诊断与治疗. 肝胆胰外科杂志, 2018, 30(2): 167-169.
23. 钟井松, 胡春洪, 沈海林. 良、恶性胰腺导管内乳头状黏液性肿瘤 CT 特征与病理联系. 临床放射学杂志, 2015, 34(1): 66-69.
24. Rodriguez JR, Salvia R, Crippa S, et al. Branch-duct intraductal papillary mucinous neoplasms: observations in 145 patients who underwent resection. Gastroenterology, 2007, 133(1): 72-79.
25. Sohn TA, Yeo CJ, Cameron JL, et al. Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Ann Surg, 2004, 239(6): 788-797.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Diagnosis and treatment of 45 patients with pancreas intraductal papillary mucinous neoplasm

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