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Side branch IPMN

Yazan S Khaled, Muhammed Mohsin, Kavi Fatania, Ada Yee, Robert Adair, Maria Sheridan, Christian Macutkiewicz, Amer Aldouri, Andrew M Smith
INTRODUCTION: Side branch IPMN (SB-IPMN) of the pancreas has a malignancy rate between 10 and 20%. We hypothesized that surveillance at longer intervals on selected patients with SB-IPMN might be indicated. METHODS: This is a retrospective study of prospectively collected data of 276 patients presenting from 2000 to 2010. After 2007, we opted to screen our patients with longer intervals, initially at 12 months then 24 months using MR if no "worrisome features" were present...
August 30, 2016: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Junpei Yamaguchi, Mari Mino-Kenudson, Andrew S Liss, Sanjib Chowdhury, Timothy C Wang, Carlos Fernández-Del Castillo, Keith D Lillemoe, Andrew L Warshaw, Sarah P Thayer
BACKGROUND & AIMS: Little is known about the origin of pancreatic intraductal papillary mucinous neoplasms (IPMN). Pancreatic duct glands (PDGs) are gland-like outpouches budding off the main pancreatic ducts that function as progenitor niche for the ductal epithelium; they express gastric mucins and have characteristics of side-branch IPMN. We investigated whether PDGs are a precursor compartment for IPMN and the role of trefoil factor family 2 (TFF2)- a protein expressed by PDGs and the gastric mucosa that are involved in epithelial repair and tumor suppression...
August 11, 2016: Gastroenterology
Silvia Lana, Manuela Vallara, Nicola Emanuele Bono, Giuseppe Russo, Giulia Artioli, Giovanni Capretti, Ilaria Paladini, Antonella Pesce, Margherita Ruggirello, Sandro Barbalace, Maurizio Mostardi
Cystic lesions of the pancreas are relatively frequent imaging findings due to the improvement of imaging technologies. They may be secondary to both benign and malignant disease processes and their prevalence increases with age. In most cases, these lesions are detected incidentally by computed tomography and magnetic resonance imaging (MRI) performed for other reasons. Intraductal papillary mucinous neoplasms (IPMNs) represent 25% of the cystic neoplasms, morphologically classified into "main pancreatic duct IPMN" (MPD-IPMN), "side branches IPMN" (SB-IPMN) and mixed forms...
2016: Acta Bio-medica: Atenei Parmensis
Selma J Lekkerkerker, Marc G Besselink, Olivier R Busch, Frederike Dijk, Marc R Engelbrecht, Erik A Rauws, Paul Fockens, Jeanin E van Hooft
UNLABELLED: * OBJECTIVE: Patients with potentially premalignant neoplastic pancreatic cysts without high-risk stigmata usually enter a surveillance program. Data on outcomes of such surveillance programs are scarce. We aimed to evaluate the resection rate and malignancy rate during follow-up. MATERIAL AND METHODS: From our prospective database (2006-2015) of patients with pancreatic cysts, we analyzed patients with pancreatic cysts without high-risk stigmata with at least six months follow-up...
September 2016: Scandinavian Journal of Gastroenterology
Mohammad H Shakhatreh, Sohrab Rahimi Naini, Alan A Brijbassie, Douglas J Grider, Perry Shen, Paul Yeaton
BACKGROUND AND AIMS: Pancreatic cysts are becoming more common. Their differential diagnosis includes benign, premalignant, and malignant lesions. Distinguishing the type of cyst helps in the management decision making. We report on a novel tissue acquisition device for pancreatic cysts. METHODS: Data on two patients who underwent endoscopic ultrasound (EUS) - guided fine-needle aspiration with a new micro forceps device are presented. RESULTS: Two patients had large pancreatic cystic lesions in the pancreatic head...
April 2016: Endoscopy International Open
Lars Grenacher, Albert Strauß, Frank Bergmann, Matthew Birdsey, Julia Mayerle
BACKGROUND: Intraductal papillary mucinous neoplasms (IPMNs) display diverse macroscopic, histological, and immunohistochemical characteristics with typical morphological appearance in magnetic resonance imaging. Depending on those, IPMNs may show progression into invasive carcinomas with variable frequency. Overall, IPMN-associated invasive carcinomas are found in about 30% of all IPMNs, revealing phenotpyes comparable with conventional ductal adenocarcinomas or mucinous (colloid) carcinomas of the pancreas...
February 2015: Viszeralmedizin
Elizabeth Thomas, Lea Matsuoka, Sophoclis Alexopoulos, Rick Selby, Dilip Parekh
BACKGROUND: The diagnosis of side-branch intraductal papillary mucinous neoplasms (IMPNs) is increasingly more common, but their appropriate management is still evolving. We recently began performing laparoscopic hand-assisted enucleation or duodenal-sparing pancreatic head resection for these lesions with vigilant postoperative imaging. MATERIALS AND METHODS: Seventeen patients with pancreatic cystic lesions were included in this single-center retrospective review from January 1, 2008 to March 30, 2013...
August 2015: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
John D Dortch, John A Stauffer, Horacio J Asbun
BACKGROUND: Given the malignant potential of main duct intraductal papillary mucinous neoplasm (M-IPMN), surgical resection is generally indicated. With regard to side-branch intraductal papillary mucinous neoplasm (SB-IPMN), resection vs. observation is a topic of debate. Further review of SB-IPMN is necessary to clarify appropriate management. The primary focus of this project is to determine the incidence of malignant final pathology for patients undergoing surgery for isolated SB-IPMN with non-malignant fine-needle aspiration (FNA) cytology...
September 2015: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Ali A Siddiqui, Haroon Shahid, Apeksha Shah, Tanvi Khurana, William Huntington, Saad S Ghumman, David E Loren, Thomas E Kowalski, Sobia Laique, Umar Hayat, Mohamad A Eloubeidi
BACKGROUND AND OBJECTIVES: Data on the risk of acute pancreatitis following endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic cystic lesions are limited. The aim of our study was to evaluate the frequency of acute pancreatitis after EUS-FNA of pancreatic cysts and solid lesions, and determine whether there was a difference in pancreatitis risk in patients with side branch intraductal papillary mucinous neoplasms (SB-IPMN). PATIENTS AND METHODS: A retrospective review of patients who underwent EUS-FNA of pancreatic cysts and solid lesions was performed...
April 2015: Endoscopic Ultrasound
Safi Dokmak, Béatrice Aussilhou, Fanjandrainy Rasoaherinomenjanahary, Fadhel Samir Ftériche, Manuela Cesaretti, Jacques Belghiti, Alain Sauvanet
BACKGROUND: Although laparoscopic surgery is now extensively used, laparoscopic middle pancreatectomy (LMP) has rarely been described. STUDY DESIGN AND METHODS: A 45-year-old woman was diagnosed with branch duct intraductal papillary mucinous neoplasia (IPMN) at the pancreatic neck, which was discovered after numerous attacks of acute pancreatitis. LMP was decided on for treatment. RESULTS: The patient underwent pure LMP with right to left dissection and one-layer pancreatogastric anastomosis...
March 2015: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
Stefan Fritz, Thilo Hackert, Markus W Büchler
Cystic lesions of the pancreas are increasingly recognized due to the widespread use of modern abdominal imaging technologies. The majority of these lesions display pseudocysts and mucinous cystic neoplasms. In contrast to pseudocysts, it is well established that mucinous cystic neoplasms of the pancreas exhibit a significant potential for malignant transformation over time. Among mucinous cystic tumors, the most frequently observed entity is pancreatic intraductal papillary mucinous neoplasm (IPMN). IPMNs are characterized by cystic dilation of pancreatic ducts and the production of mucus and by an adenoma-carcinoma sequence eventually culminating in invasive carcinoma in some patients...
2015: Digestive Diseases
Xiaodong Tian, Hongqiao Gao, Yongsu Ma, Yan Zhuang, Yinmo Yang
INTRODUCTION: The indications, the extent and type of surgery for intraductal papillary mucinous neoplasm (IPMN) are still controversial. This study aimed to investigate clinical manifestation, individualized surgical treatment, and prognosis of IPMN of pancreas. METHODS: The clinical data of 96 IPMN cases treated in our hospital between January 2006 and December 2013 were retrospectively analyzed. Among the 96 patients (58 male and 38 female), 46 were main-duct type, 29 were branch-duct type, 21 were mixed type...
January 2015: International Journal of Surgery
Giovanni Marchegiani, Carlos Fernández-del Castillo
Management of Bd-IPMN remains challenging. Critical appraisal of the published literature reveals that the actual treatment of what is presumed to be Bd-IPMN remains unsatisfactory, with a high rate of surgically overtreated patients. Until we accrue more precise knowledge of the natural history of Bd-IPMN, management of patients with this presumed diagnosis should be individually tailored and preferably carried out in centers with a high expertise. For now, the authors strongly think that the old guidelines should be followed in most patients because these have proven to correctly identify lesions that can be safely followed...
2014: Advances in Surgery
Andrei S Purysko, Namita S Gandhi, R Mathew Walsh, Nancy A Obuchowski, Joseph C Veniero
OBJECTIVES: To assess the value of secretin during magnetic resonance cholangiopancreatography (MRCP) in demonstrating communication between cystic lesions and the pancreatic duct to help determine the diagnosis of side-branch intraductal papillary mucinous neoplasm (SB-IPMN). METHODS: This is an IRB-approved, HIPAA-compliant retrospective study of 29 SB-IPMN patients and 13 non-IPMN subjects (control) who underwent secretin-enhanced MRCP (s-MRCP). Two readers blinded to the final diagnosis reviewed three randomised image sets: (1) pre-secretin HASTE, (2) dynamic s-MRCP and (3) post-secretin HASTE...
December 2014: European Radiology
Fernando Gallucci, Assunta Langellotto, Rosaria De Ritis, Generoso Uomo
Intraductal papillary mucinous neoplasms (IPMNs) are rare pancreatic tumours, accounting for less of 1-2% of all neoplasms of the gland. Main characteristics of IPMNs are their favourable prognosis as these pre-malignant or frankly malignant lesions are usually slow-growing tumours and radical surgery is frequently possible. According with the localization of the lesions, three different entities are identified: the main-duct IPMN (type I), the branch-duct IPMN (type II) and the mixed type (type III, involving both the main pancreatic duct and side branches)...
2012: Gastroenterology and Hepatology From Bed to Bench
Xiao-dong Tian, Guang-dong Wu, Yan Zhuang, Xiao-chao Guo, Yin-mo Yang
OBJECTIVE: To investigate the clinical manifestation, individualized surgical treatment, and prognosis of intraductal papillary mucinous neoplasms (IPMN) of pancreas. METHODS: The clinical data of 56 IPMN cases treated between January 2007 and December 2011 was retrospectively analyzed. Among the 56 patients (38 male and 18 female, mean age (61 ± 7) years), 26 were main-duct type, 18 were branch-duct type, 12 were mixed type. Pancreatectomy was performed on 48 cases, including pancreaticoduodenectomy on 29 patients, distal pancreatectomy on 17 patients, and total pancreatectomy on 2 patients...
July 2013: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Sari Räty, Juhani Sand, Johanna Laukkarinen, Kaija Vasama, Claudio Bassi, Roberto Salvia, Isto Nordback
OBJECTIVE: Differential diagnosis between benign and potentially malignant cystic pancreatic lesions may be difficult. Previously we have compared cyst fluid serine protease inhibitor Kazal type I (SPINK1) with some traditionally used tumour markers (amylase, CEA, Ca19-9) and found that it may be a new promising maker in the differential diagnosis of cystic pancreatic lesions. In the present study, we focused on cyst fluid SPINK1 levels in benign and potentially malignant cystic pancreatic lesions...
September 2013: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
Federica Castelli, Davide Bosetti, Riccardo Negrelli, Valerio Di Paola, Lisa Zantedeschi, Anna Ventriglia, Riccardo Manfredi, Roberto Pozzi Mucelli
PURPOSE: The aim of our study was to follow the evolution over time of multifocal intraductal papillary mucinous neoplasms (IPMN) of the pancreatic duct side branches by means of magnetic resonance imaging (MRI). MATERIALS AND METHODS: A total of 155 patients with multifocal IPMN of the side branches were examined with MRI and MR cholangiopancreatography (MRI/MRCP). Inclusion criteria were patients with ≥2 dilated side branches involving any site of the parenchyma; presence of communication with the main pancreatic duct and previous investigations by MRI/MRCP within at least six months...
September 2013: La Radiologia Medica
Kenichi Hirabayashi, Giuseppe Zamboni, Hiroyuki Ito, Masami Ogawa, Yoshiaki Kawaguchi, Tomohiro Yamashita, Toshio Nakagohri, Naoya Nakamura
Solid pseudopapillary neoplasm (SPN) is a rare and low-grade malignant pancreatic neoplasm composed of poorly cohesive monomorphic neoplastic cells forming solid and pseudopapillary structures with frequent hemorrhagic-cystic degeneration. Intraductal papillary mucinous neoplasm (IPMN) is a pancreatic exocrine tumor composed of intraductal papillary growth of mucin containing neoplastic cells in the main pancreatic duct or its major branches. In the case presented here, a 53-year-old, Japanese man was found to have multiple cystic lesions and dilatation of the main pancreatic duct in the neck of the pancreas...
June 7, 2013: World Journal of Gastroenterology: WJG
Siva P Raman, Satomi Kawamoto, Amanda Blackford, Ralph H Hruban, Ann Marie Lennon, Anne Marie O'Brien-Lennon, Christopher L Wolfgang, Neda Rezaee, Barish Edil, Elliot K Fishman
OBJECTIVE: The criteria for resection of solitary pancreatic side-branch intraductal papillary mucinous neoplasm (IPMN) have been well described by the Sendai consensus statement. However, the management of multiple pancreatic cystic lesions is less certain, with no clear guidelines in the literature to date. The purpose of this study was to evaluate the histopathologic findings in pancreatic IPMNs in patients with multiple (≥ 4) pancreatic cysts. MATERIALS AND METHODS: The CT scans of all patients with a pathologically proven IPMN at our institution were reviewed, and a total of 52 patients with four or more pancreatic cysts were found...
March 2013: AJR. American Journal of Roentgenology
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