MDCT在胰腺导管内乳头状黏液瘤中的应用

胰腺导管内乳头状黏液瘤（intraductal papillary mueinotls neoplasm．IPMN）是一种少见的胰腺囊性肿瘤。根据世界卫生组织的定义．IPMN起源于胰腺主胰管或分支胰管内的导管上皮．向胰管内呈乳头状生长并分泌大量黏液．进而导致胰管扩张或囊性灶形成。IPMN具有潜在恶变可能．可由良性腺瘤逐步进展为交界性肿瘤、原位癌或浸润性腺癌．前二者预后相对较好,而一旦发展为浸润性腺癌．则预后较差。     

胰腺导管内乳头状黏液性肿瘤的诊治进展

胰腺导管内乳头状黏液性肿瘤（IPMN）1982年由日本Ohhashi等首先报道，以后陆续有少量病例报道，近十年以来报道的病例数明显增加，目前国外文献中上百例报道也有数篇，但国内仅见1篇8例报道。对该肿瘤曾有过多种不同命名，如产黏液癌、高分泌黏液癌、导管内乳头状肿瘤、导管高分泌黏液肿瘤、导管内癌、导管产黏液肿瘤、导管扩展型黏液性囊腺瘤和囊腺癌、黏液性导管扩展症、胰管扩展型产黏液肿瘤等。1996年WHO颁布IPMN的诊断标准，以期将其与胰腺黏液性囊腺瘤或胰腺黏液性囊腺癌区分开来。在临床与病理方面，IPMN与后者也有明显的差异。     

胰腺导管内乳头状黏液性肿瘤的诊断与治疗

[摘 要] 目的 提高对胰腺导管内乳头状黏液性肿瘤（intraductal papillary mucinous neoplasm,IPMN）的认识和诊治水平。方法 对2005年7月至2017年3月洛阳市第二中医院普外科收治的19例IPMN患者的临床资料进行回顾性分析。结果 19例胰腺PIMN患者主胰管型6例（31.6%）,分支胰管型9例（47.4%）,混合型4例（21.1%）;12例胰腺IPMN行胰十二指肠切除术,其中1例行胰十二指肠并门静脉切除术;3例行胰体尾切除术;4例行胰腺局部切除术。结论 胰腺导管内乳头状黏液性肿瘤是一种预后较好的胰腺肿瘤,早期手术切除疗效满意,预后良好。     

十二指肠乳头及胰腺内多发性乳头状黏液性囊性肿瘤一例

胰腺导管内乳头状黏液性肿瘤（intraductal papillary mucinous neoplasm in pancreas,IPMN）是由胰腺导管内能够分泌黏液的高柱状上皮细胞呈乳头状增生形成的肿瘤,伴有主胰管或其侧支胰管的囊性病变,与胰腺癌相比具有低度恶性、生长缓慢的特点.在临床工作当中,笔者遇到1例IPMN且合并肝内外胆管扩张的患者,现报道如下.     

胰腺导管内乳头状黏液性肿瘤的诊治策略

胰腺导管内乳头状黏液性肿瘤（intraductal papillary mucinous neoplasm,IPMN）分主胰管型、混合型和分支胰管型。主胰管型、混合型和有症状的分支胰管型IPMN建议行手术切除,对恶性IPMN,需行规则性胰腺切除。对良性和交界性IPMN,可行功能保留性胰腺手术。对暂时不行手术切除的IPMN病人,应定期随访。IPMN的治疗决策需综合考虑各方面因素,包括病人的预期寿命、身体状况、治疗意愿、依从性、随访的条件等加以综合评估,最后形成个体化的治疗方案。     

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胰腺导管内乳头状黏液性肿瘤(intraductal papil-lary mucinous neoplasm,IPMN)分主胰管型、混合型和分支胰管型。主胰管型、混合型和有症状的分支胰管型IPMN建议行手术切除,对恶性IPMN,需行规则性胰腺切除。对良性和交界性IPMN,可行功能保留性胰腺手术。对暂时不行手术切除的IPMN病人,应定期随访。IPMN的治疗决策需综合考虑各方面因素,包括病人的预期寿命、身体状况、治疗意愿、依从性、随访的条件等加以综合评估,最后形成个体化的治疗方案。     

胰腺导管内乳头状黏液性肿瘤的临床病理学分析

胰腺导管内乳头状黏液性肿瘤（IPMN）是近几年才被逐渐认识的一类胰腺囊性肿瘤，约占临床诊断胰腺肿瘤的7．5％和手术切除胰腺肿瘤的16．3％，具有产生大量黏液蛋白、胰腺导管囊性扩张和伴有导管内乳头生成的特点。本文总结我院近年来诊治的24例IPMN患者的临床病理学资料，报告如下。[第一段]     

外科治疗在胰腺导管内乳头状黏液性肿瘤的研究进展

胰腺导管内乳头状黏液性肿瘤(intraductal papillary mucinous neoplasm,IPMN)是一类累及主胰管或分支胰管的产黏液肿瘤,同时缺乏黏液性囊腺瘤的特征,IPMN有进展为胰腺导管腺癌的可能,目前很多研究都在探讨IPMN的发病机制及其诊断,并取得了进展,然而对其手术适应证及其手术方式并没有...     

胰腺导管内乳头状粘液性肿瘤

胰腺导管乳头状粘液性肿瘤(IPMN)曾称绒毛状或乳头状肿瘤、产粘蛋白肿瘤、胰管扩张型粘液样囊腺癌，所谓乳头状囊性肿瘤现正名为实质性假乳头状肿瘤，与IPMN无关和无相同处。导管内肿瘤细胞乳头状肿瘤与IPMN很相似，但其肿瘤细胞形态学是不同的。含有丰富的线粒体，其乳头状形式也较复杂，     

胰腺导管内乳头状黏液肿瘤的分子病理学研究进展

胰腺导管内乳头状黏液肿瘤(IPMN)是一种较少见的胰腺囊性肿瘤,具有恶变为胰腺导管腺癌的风险,且一旦发生恶变,预后较差。目前国内外针对IPMN的研究较少,因此,更好地理解其发生发展的分子病理学机制对于该疾病的诊断、治疗和预后改善具有重要意义。已发现多种癌基因、抑癌基因、信号通路等分子参与了IPMN的发生发展及恶变过程,笔者着重对IPMN的分子病理学研究进展进行综述。     

胰腺导管内乳头状黏液性肿瘤的影像学表现

[摘 要] 目的 探讨胰腺导管内乳头状黏液性肿瘤（intraductal papillary mucinous neoplasm,IPMN）的影像学表现。方法 回顾性分析50例经手术病理证实的胰腺IPMN患者,所有患者均于术前行动态增强三期螺旋CT和MRCP检查,并行外科手术治疗取得病理结果。结果 主胰管型IPMN 25例,表现为主胰管扩张伴管壁结节样突起;分支胰管型IPMN 12例,表现为单发囊性病变或葡萄串样多发囊性病变伴腔内分隔或结节样突起;混合型IPMN 13例,表现为主胰管扩张和囊性病变合并存在。结论 所有类型的IPMN都具有与胰管相通,并引起肿瘤上下游胰管扩张的特点。多层螺旋CT和MRCP对发现和诊断胰腺IPMN具有较高价值。     

Mucin-producing Bile Duct Tumor of the Caudate Lobe Protruding into the Common Hepatic Duct

Mucin-producing tumor in the bile duct is referred to clinically as mucin-producing bile duct tumor (MPBT). Intraductal papillary neoplasm of the biliary tract that resembles an intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a rare category of MPBT and is not well characterized. We, herein, report a case of MPBT of the caudate lobe of the liver that showed papillary growth and communicated with the bile duct of the caudate lobe and protruded into the common hepatic duct. Histologically, MPBT cells showed papillary overgrowth with abundant mucinous secretions, resembling an IPMN of the pancreas. The MPBT cells showed the same immunostaining pattern as that of cells from IPMN of the pancreas.     

Zystische Tumoren des Pankreas

Cysts of the pancreas most often develop after chronic or acute inflammation of the pancreas. Cystic neoplasia of the pancreas have been increasingly recognized in clinical practice and 90% are represented by four types: serous microcystic (SCN), mucinous cystic (MCN), intraductal papillary-mucinous (IPMN) and solid pseudopapillary (SPN) neoplasia. IPMN is the most common form nowadays and main duct and branch duct types can be differentiated by morphology. This classification is of prognostic and therapeutic relevance. While main duct IPMNs have a high risk of malignant progression and resection is therefore recommended, branch duct IPMNs have a much lower risk of harboring malignancy. Small branch duct IPMNs (<2 cm) without symptoms or mural nodules can be managed by periodic surveillance. Recently, it has become clear that IPMN constitutes a heterogeneous group with at least four subtypes. Their stratification reveals that the various subtypes of IPMN have different biological properties with different prognostic implications, but the subclassification is usually not known prior to surgery. Moreover, even differentiation between inflammatory and neoplastic cysts can be challenging. Clear indications for resection are local complications (jaundice or gastric outlet obstruction), large and increasing tumurs, symptoms or secretion of mucinous fluid from the papilla of Vater.     

Intraductal papillary mucinous neoplasm of the pancreas associated with neuroendocrine tumor: A case report

IntroductionIntraductal papillary mucinous neoplasm is an uncommon cystic tumor of pancreas that can be associated with ductal adenocarcinoma. Coexistence of pancreatic IPMN and neuroendocrine tumor is very rare. Here, we report the imaging features of mixed type intraductal papillary mucinous neoplasia of the pancreas with high grade dysplasia together with neuroendocrine carcinoma and perform review of the literature.PresentationA 68-year old patient has been evaluated for possible IPMN that was suspected during ultrasound. MRI revealed main and side branch duct dilatations. At the head, a contrast enhancing nodular lesion was identified. Due to the presence of high risk stigmata according to guidelines, surgery was performed. Histopathological examination revealed an unusual association, including mixed type IPMN and neuroendocrine carcinoma.DiscussionThe concomitant occurrence of pancreatic IPMN and neuroendocrine tumor has been reported in case studies and brief reviews. Yet, the imaging findings and underlying molecular mechanisms of this entity has not been fully understood. In addition to this unusual association, pancreatic intraepithelial neoplasia was also detected in the present case. Although majority of neuroendocrine tumor associated IPMNs were reported to be having low grade dysplasia, our patient had high grade dysplasia. Further studies and reviews with larger groups are needed to establish imaging features and underlying molecular mechanisms of this rare association.ConclusionAlthough the major concern during work-up of IPMN is presence of associated pancreatic ductal adenocarcinoma, the possibility of neuroendocrine tumor, in the presence of a hypervascular solid foci on imaging studies should be kept in mind.     

Dorsal pancreatectomy: An embryology-based resection

In a 45-year-old man with acute pancreatitis and recent onset of diabetes mellitus, intraductal papillary mucinous neoplasm (IPMN) associated with pancreas divisum was found. There were no arguments for an invasive component in the IPMN lesions, which seemed to involve nearly all the dorsal pancreas. Re-section of only the dorsal pancreas was performed with division of the pancreas at the internal side of the duodenum and at the anterior edge of the common bile duct. The gastroduodenal artery was preserved resulting in good vascularization of both common bile duct and proximal duodenum. Postoperative course was marked by a transient pancreatic fistula. Definitive pathological examination revealed nonin-vasive IPMN involving several branch ducts and partially the cephalic dorsal duct, with an 8 mm tumor-free segment from the transection level. Twelve months after resection, the patient had normal gastro-intestinal function with neither clinical exocrine insufficiency nor uncontrolled diabetes. Postoperative magnetic resonance imaging revealed no signs of recurrence in the ventral pancreas. In patients with pancreas divisum, dorsal pancreatectomy can be proposed for noninvasive IPMN involving only the dorsal pancreas to avoid drawbacks of total duodenopancreatic resection.     

Favorable Response After Gemcitabine-Radiotherapy for Invasive Pancreatic Intraductal Papillary Mucinous Neoplasm: A Case Report

The efficacy of chemoradiotherapy for invasive pancreatic ductal carcinoma derived from an intraductal papillary mucinous neoplasm (IPMN) has not been established. The subject of the present report was a 53-year-old man admitted for the treatment of IPMN. The tumor, located in the pancreatic body, was of the mixed type of IPMN, and it involved the branch duct, where it was 38 mm in diameter, and the main duct, where it was 6 mm in diameter. Distal pancreatectomy was performed and the postoperative course was uneventful; however, histopathologic diagnosis revealed invasive ductal carcinoma with a positive surgical margin in the pancreatic duct. Although total pancreatectomy was recommended, chemoradiotherapy (50.4-Gy irradiation and gemcitabine) was preferred by the patient. At 9-month follow up, computed tomography and magnetic resonance imaging showed a cystic mass at the surgical margin of the pancreas. Endoscopic ultrasonography showed a 44-mm cystic lesion with nodules in the remnant pancreas, on the basis of which he underwent total pancreatectomy. Pathologic examination of the resected specimen revealed absence of the epithelium at the surgical margin of the main pancreatic duct, and malignant cells were not detected.     

Pancreatobiliary fistula associated with an intraductal papillary-mucinous pancreatic neoplasm manifesting as obstructive jaundice: Report of a case

We report a pancreatobiliary fistula caused by an intraductal papillary-mucinous pancreatic neoplasm (IPMN), manifesting as obstructive jaundice. Computed tomography showed dilatation of the bile duct and main pancreatic duct, with multiple cystic masses in the head of the pancreas. Endoscopic retrograde pancreatocholangiography showed a patulous papilla with mucin secretion. Contrast enhancement outlined amorphous material obstructing the lower part of the common hepatic duct. Pancreatogram and magnetic resonance cholangiopancreatography showed diffuse dilatation of the main pancreatic duct and side branches without communication with the adjacent organs or duct. We performed pancreaticoduodenectomy for IPMN of the pancreatic head and a tumor-like lesion in the lower common bile duct (CBD). Macroscopically, impacted thick mucus protruded into the CBD from the pancreas via a pancreatobiliary fistula. Histologic examination revealed a pancreatobiliary fistula caused by intraductal papillary-mucinous carcinoma of the pancreas with mucin hypersecretion, an adenoma without interstitial infiltration, and isolated implantation of an IPMN in the bile duct mucosa around the fistula.     

IPMN: surgical treatment

Purpose

Cystic pancreatic tumors are being detected more frequently, and particularly, intraductal papillary mucinous neoplasia (IPMN) has recently attracted increased attention. The detection rate of IPMN has increased over the last decade; however, management of this neoplasm remains controversial.

Methods

Based on a review of the relevant literature and the international guidelines, we discuss the diagnostic evaluation of IPMN, its treatment, and prognosis.

Results

While IPMN represents only a distinct minority of all pancreatic cancers, they appear to be a relatively frequent neoplastic form of pancreatic cystic neoplasm. It may not be possible to differentiate main duct disease from branch duct disease (MD-IPMN vs. BD-IPMN) prior to surgery. This distinction has not only an impact on treatment but also on prognosis, as MD-IPMN is more often malignant. IPMN has updated consensus guideline indications for conservative and surgical resection.

Conclusions

Since patients with IPMN of the pancreas are at risk of developing recurrent IPMN and pancreatic ductal adenocarcinoma in the remnant pancreas and extrapancreatic malignancies, early recognition, treatment, and systemic surveillance are of great importance. No conclusions can be drawn from the available evidence with respect to the efficacy of surveillance and follow-up treatment programs. A better understanding of the natural course of IPMN and the biology of pancreatic cancer is mandatory to enable further diagnostic and treatment improvements.     

Repeated Pancreatectomy after Pancreatoduodenectomy

Background When pancreatic duct dilatation is found in the patient having undergone pancreatoduodenectomy (PD), observation is chosen in most cases. Similarly, recurrent tumor in the remnant pancreas of invasive ductal carcinoma (IDC) of the pancreas is seldom indicated for resection. We have aggressively performed repeated pancreatectomy for these cases and obtained good results. Methods Repeated pancreatectomy after PD was performed for three types of circumstances: (1) pancreatodigestive anastomotic stricture; (2) neoplasm after intraductal papillary mucinous neoplasm (IPMN); and (3) recurrence of IDC of the pancreas. Results Resection of anastomosis and reanastomosis was performed for pancreatodigestive stricture in four patients. Symptoms derived from pancreatitis in three patients resolved by the second operation and did not recur during follow-up. None of the four patients required pancreatic enzyme substitution because of clinically overt malabsorption, and the defecation frequency of the four patients was within twice a day. Mild diabetes mellitus has been identified in only one patient who had diabetes mellitus before the second surgery. Completion pancreatectomy and pancreatic tail resection was performed for recurrence in two patients and IDC in one patient, respectively, after PD for IPMN. Intrapancreatic recurrences of IPMN in two patients existed in the main pancreatic ducts. As CT revealed pancreatic duct dilatation but not intraductal tumors, recurrences were not correctly diagnosed before the second operation. Completion pancreatectomy was performed for recurrence of IDC in two patients. One patient who underwent completion pancreatectomy for recurrence of IDC survived 66/44 months after the first/second operation. Conclusion Repeated pancreatectomy should be performed for patients with pancreatodigestive anastomotic stricture to preserve remnant pancreatic function and for patients with neoplasm or pancreatic duct dilatation after PD for IPMN, and repeated pancreatectomy for recurrence of IDC might be indicated for selected patients.     

胰腺导管内乳头状黏液性肿瘤27例诊治分析

目的总结胰腺导管内乳头状黏液性肿瘤(IPMN)的诊治经验,寻找术前预测浸润性IPMN的指标.方法将2003年9月-2010年7月手术治疗的27例胰腺IPMN病例分为浸润性与非浸润性IPMN两组,分析比较两组间术前资料的差异.结果浸润性IPMN 15例,非浸润性IPMN12例.两组间术前梗阻性黄疸发病率、肿瘤最大直径、血...