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Presentation, treatment and prognosis of intraductal papillary mucinous neoplasm
Intraductal papillary mucinous neoplasms (IPMNs) are rare tumours rising from the pancreatic duct epithelium. They
are characterized by intraductal papillary growth and thick mucin secretion; mucin fills the Wirsung and/or branch pancreatic
ducts and may cause ductal dilatation. IPMNs are classified into three types, according to the site of involvement:
main duct type, branch duct type, and combined type. Most branch type IPMNs are benign, while the other two
types are frequently malignant. Recent advances in diagnostic imaging have led to an increased frequency of diagnosis
of IPMNs, but the clinical features of them can range broadly from benign, borderline, and malignant non-invasive to
invasive lesions, and their management has not yet been clearly defined. The most of patients are asymptomatic. The
possibility of malignancy is increased in cases which large mural nodules are presented. Presence of a large branch type
IPMN and marked dilatation of the main duct indicate the existence of adenoma. Not infrequently, synchronous or
metachronous malignancies may be developed in various organs. Endoscopic retrograde cholangiopancreatography (ERCP),
endoscopic ultrasonography (EUS), intraductal ultrasonography, and magnetic resonance cholangiopancreatography (MRCP)
are the most valuable imaging techniques for diagnosis of these lesions. Prognosis is excellent after complete resection of
benign and non-invasive malignant IPMNs. Total pancreatectomy should be reserved for patients with resectable but
extensive IPMN involving the whole pancreas; its benefits must be balanced against perioperative risks.
