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Intraductal papillary mucinous neoplasm
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<h2 id="histology">Histology</h2> <p>IPMNs are lined with mucin-secreting columnar epithelium. </p> <h2 id="diagnosis">Diagnosis</h2> <p>In most cases, IPMNs are diagnosed based on clinical and radiographic criteria.<a class="footnote-ref" id="fnref:5" href="#fn:5"><sup>5</sup></a> If fluid from the cyst is aspirated, the CEA level is typically elevated.<a class="footnote-ref" id="fnref:6" href="#fn:6"><sup>6</sup></a> Confirmation of the diagnosis with tissue is rarely necessary.<a class="footnote-ref" id="fnref:7" href="#fn:7"><sup>7</sup></a> </p><p>By <a href="/facts/Histopathology/9Eggjrg4">histopathology</a>, IPMN is characterized on <a href="/facts/Light_microscopy/GpHlElDS">light microscopy</a> by Mucinous epithelial cells,<a class="footnote-ref" id="fnref:8" href="#fn:8"><sup>8</sup></a> and growth within the <a href="/facts/Pancreatic_duct/tLKRDmSE">pancreatic ducts</a>.<a class="footnote-ref" id="fnref:9" href="#fn:9"><sup>9</sup></a> <a href="/facts/Mucin_5AC/6QIQ4CvW">Mucin 5AC</a> is a useful <a href="/facts/Immunohistochemistry/knPpmAFf">immunohistochemistry</a> marker.<a class="footnote-ref" id="fnref:10" href="#fn:10"><sup>10</sup></a> Characteristic genetic alterations are those of <a href="/facts/KRAS/NSVQ0ALz">KRAS</a> and <a href="/facts/GNAS_complex_locus/uIlIY38T">GNAS</a>.<a class="footnote-ref" id="fnref:11" href="#fn:11"><sup>11</sup></a> </p><p>Further subtyping of IPMN can be done as either:<a class="footnote-ref" id="fnref:12" href="#fn:12"><sup>12</sup></a> </p> <ul><li><a href="/facts/Gross_pathology/KB25FEpD">Gross pathology</a>: Main duct, branch duct, and mixed duct lesions, which determines surgical management. Main duct lesion is the segmental or diffuse dilatation of main pancreatic duct greater than 5 mm without other causes of obstruction. Meanwhile, branch duct lesion is the pancreatic cyst more than 5 mm that communicates with the main duct. The mixed duct lesions fulfills both criteria above.<a class="footnote-ref" id="fnref:13" href="#fn:13"><sup>13</sup></a></li> <li>By <a href="/facts/Light_microscopy/GpHlElDS">light microscopy</a> and <a href="/facts/Immunohistochemistry/knPpmAFf">immunohistochemistry</a>:<a class="footnote-ref" id="fnref:14" href="#fn:14"><sup>14</sup></a> Gastric, intestinal, pancreaticbiliary, and oncocytic.</li></ul> <h2 id="treatment">Treatment</h2> <p>The treatment of choice for main-duct IPMNs is resection due to approximately 50% chance of malignancy. Side-branch IPMNs are occasionally monitored with regular CT or MRIs, but most are eventually resected, with a 30% rate of malignancy in these resected tumors. Indications for surgical resection include obstructive jaundice, an enhancing mural nodule >5 mm, and pancreatic duct dilation (>10 mm).<a class="footnote-ref" id="fnref:15" href="#fn:15"><sup>15</sup></a> </p><p>Surgery can include the removal of the head of the pancreas (a <a href="/facts/Pancreaticoduodenectomy/KqnXSoVH">pancreaticoduodenectomy</a>), removal of the body and tail of the pancreas (a <a href="/facts/Distal_pancreatectomy/NQk6J4No">distal pancreatectomy</a>), or rarely removal of the entire pancreas (a total pancreatectomy).<a class="footnote-ref" id="fnref:16" href="#fn:16"><sup>16</sup></a> In selected cases the surgery can be performed using minimally invasive techniques such as <a href="/facts/Laparoscopy/cTMKggTn">laparoscopy</a><a class="footnote-ref" id="fnref:17" href="#fn:17"><sup>17</sup></a> or robotic surgery. A study using <a href="/facts/Surveillance,_Epidemiology,_and_End_Results/1fLVhEKB">Surveillance, Epidemiology, and End Results</a> Registry (SEER) data suggested that increased lymph node counts harvested during the surgery were associated with better survival in invasive IPMN patients.<a class="footnote-ref" id="fnref:18" href="#fn:18"><sup>18</sup></a> </p> <h2 id="prognosis">Prognosis</h2> <p>Survival 5 years after resection of an IPMN without malignancy is approximately 80%, 85% with malignancy but no lymph node spread and 0% with malignancy spreading to lymph nodes.<a class="footnote-ref" id="fnref:19" href="#fn:19"><sup>19</sup></a> </p> <h2 id="epidemiology">Epidemiology</h2> <p>Side branch IPMNs are the most common pancreatic cysts.<a class="footnote-ref" id="fnref:20" href="#fn:20"><sup>20</sup></a> IPMNs occur more often in men than women, and often occur in the 6th and 7th decade of life. </p> <h2 id="history">History</h2> <p>In 1982, IPMN was reported as a "mucin-producing tumor" by Kazuhiko Ohashi of the Japanese Foundation for Cancer Research. </p> <h2 id="see-also">See also</h2> <ul><li>Intra-ampullary papillary–tubular neoplasm</li> <li><a href="/facts/Pancreatic_serous_cystadenoma/N7f5t5mX">Pancreatic serous cystadenoma</a></li> <li><a href="/facts/Solid_pseudopapillary_neoplasm/25r2mxET">Solid pseudopapillary neoplasm</a></li></ul> <h2 id="references">References</h2> <ol> <li id="fn:1"><p>"Intraductal Papillary Mucinous Neoplasms of the Pancreas". Johns Hopkins University. Archived from the original on 4 February 2021. Retrieved 7 September 2009. <a href="https://web.archive.org/web/20210204201720/https://pathology.jhu.edu/pancreas/IPMN.php" target="_blank">https://web.archive.org/web/20210204201720/https://pathology.jhu.edu/pancreas/IPMN.php</a> <a href="#fnref:1" class="footnote-back-ref">↩</a></p></li> <li id="fn:2"><p>Campbell, NM; Katz, SS; Escalon, JG; Do, RK (March 2015). "Imaging patterns of intraductal papillary mucinous neoplasms of the pancreas: an illustrated discussion of the International Consensus Guidelines for the Management of IPMN". Abdominal Imaging. 40 (3): 663–77. doi:10.1007/s00261-014-0236-4. PMID 25219664. S2CID 10097983. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:2" class="footnote-back-ref">↩</a></p></li> <li id="fn:3"><p>"Intraductal Papillary Mucinous Neoplasms of the Pancreas". Johns Hopkins University. Archived from the original on 4 February 2021. 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