Fact-sheet: Intraductal papillary mucinous tumor of pancreas
Updated on 09/27/2019 at 2:44 PM
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Definition
- Belongs to the group of cystic pancreatic tumors
- Known under multiple names until 1996 (IPMN)
- Most common (cystic) tumors of the pancreas
- Results from intraductal papillary proliferations, obstructive mucus hypersecretion, and retention-related ductal dilation
- Lesional continuum from simple mucosal hyperplasia to invasive carcinoma
Clinical features
- Mean age: 60-70 years
- Female predominance
- Often asymptomatic and incidentally discovered
- Recurrent acute pancreatitis due to transient obstruction of the main pancreatic duct by a mucus plug that is subsequently expelled
- Risk of malignant transformation into adenocarcinoma
Laboratory findings
None
Ultrasound
Cystic pancreatic lesions or homogeneous dilation of the main pancreatic duct
CT
Main-duct IPMN:
- Main pancreatic duct dilation > 3 mm (body/tail), > 4 mm (head)
- Diffuse or segmental
- Regular walls, no stricture
- Intraductal calcifications may be present
Branch-duct IPMN:
- Thin-walled cystic lesions
- Connected to the main pancreatic duct++
- Unilocular or multilocular
- Presence of septa, grape-cluster appearance
Signs of malignancy:
- Obstructive jaundice with a cystic lesion of the head
- Main pancreatic duct > 10 mm
- Enhancing solid component within the cyst
"Worrisome features":
- Cyst > 3 cm
- Main pancreatic duct 5-9 mm
- Non-enhancing intracystic mural nodule
- Abrupt change in main pancreatic duct caliber with upstream parenchymal atrophy
- Enhancing walls
MRI
Main-duct IPMN:
- Main pancreatic duct dilation > 3mm (body/tail) > 4mm (head)
- Diffuse or segmental
- Regular walls, no stricture
- Possible intraductal calcifications
Branch-duct IPMN:
- Thin-walled cystic lesions
- Communicating with the main pancreatic duct++
- Uni- or multilocular
- Presence of septa, grape-cluster appearance
- Usefulness of diffusion-weighted imaging for nodule detection
Signs of malignancy:
- Cholestatic jaundice with a cystic lesion of the head
- Main pancreatic duct > 10mm
- Enhancing solid component within the cyst
"Worrisome features":
- Cyst > 3cm
- Main pancreatic duct 5-9 mm
- Non-enhancing mural nodule
- Abrupt change in main pancreatic duct caliber with upstream parenchymal atrophy
- Enhancing walls
Management
- Signs of malignancy: surgery
- "Worrisome features": endoscopic ultrasound and MRI surveillance
- Neither: MRI surveillance
Classification
- Main-duct
- Branch-duct
- Mixed type (main duct and branch duct involvement)
Differential diagnosis
- Chronic pancreatitis
- Serous cystadenoma
- Mucinous cystadenoma
- Pseudocyst
- Cystic transformation of acini