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Difference between revisions of "Pancreas"
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→Intraductal papillary mucinous tumour: rework
(→Intraductal papillary mucinous tumour: rework) |
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*Abbreviated ''IPMT''. | *Abbreviated ''IPMT''. | ||
*[[AKA]] ''intraductal papillary mucinous neoplasm'', abbreviated ''IPMN''. | *[[AKA]] ''intraductal papillary mucinous neoplasm'', abbreviated ''IPMN''. | ||
===General=== | ===General=== | ||
*Morphologically and biologically distinct from ductal adenocarcinoma, mucinous cystic tumour and ductal papillary hyperplasia. | *Morphologically and biologically distinct from ductal adenocarcinoma, mucinous cystic tumour and ductal papillary hyperplasia. | ||
*Prognosis: favourable, if caught earlier; not much different than ductal adenocarcinoma if caught later.<ref name=pmid12377813>{{cite journal |author=Maire F, Hammel P, Terris B, ''et al.'' |title=Prognosis of malignant intraductal papillary mucinous tumours of the pancreas after surgical resection. Comparison with pancreatic ductal adenocarcinoma |journal=Gut |volume=51 |issue=5 |pages=717–22 |year=2002 |month=November |pmid=12377813 |pmc=1773420 |doi= |url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=12377813}}</ref> | *Prognosis: favourable, if caught earlier; not much different than ductal adenocarcinoma if caught later.<ref name=pmid12377813>{{cite journal |author=Maire F, Hammel P, Terris B, ''et al.'' |title=Prognosis of malignant intraductal papillary mucinous tumours of the pancreas after surgical resection. Comparison with pancreatic ductal adenocarcinoma |journal=Gut |volume=51 |issue=5 |pages=717–22 |year=2002 |month=November |pmid=12377813 |pmc=1773420 |doi= |url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=12377813}}</ref> | ||
Clinical: | |||
*Patient usually not jaundiced... as no obstruction. | |||
*Often diabetes... as pancreas is destroyed. | |||
*Patients may get a total pancreatectomy - as the disease is often multifocal. | |||
Another paper: <ref name=pmid20374620>{{cite journal |author=Baiocchi GL, Portolani N, Missale G, ''et al.'' |title=Intraductal papillary mucinous neoplasm of the pancreas (IPMN): clinico-pathological correlations and surgical indications |journal=World J Surg Oncol |volume=8 |issue= |pages=25 |year=2010 |pmid=20374620 |pmc=2858722 |doi=10.1186/1477-7819-8-25 |url=http://wjso.com/content/8/1/25}}</ref> | Another paper: <ref name=pmid20374620>{{cite journal |author=Baiocchi GL, Portolani N, Missale G, ''et al.'' |title=Intraductal papillary mucinous neoplasm of the pancreas (IPMN): clinico-pathological correlations and surgical indications |journal=World J Surg Oncol |volume=8 |issue= |pages=25 |year=2010 |pmid=20374620 |pmc=2858722 |doi=10.1186/1477-7819-8-25 |url=http://wjso.com/content/8/1/25}}</ref> | ||
===Epidemiology=== | ====Epidemiology==== | ||
*1% of all exocrine pancreatic tumours. | *~1% of all exocrine pancreatic tumours. | ||
*More common in males. | *More common in males. | ||
*Mean age at presentation 62 years. | *Mean age at presentation 62 years. | ||
*60-80% occur in the head of the pancreas. | *60-80% occur in the head of the pancreas. | ||
*Average size 4 cm. | *Average size 4 cm. | ||
===Gross=== | ===Gross=== | ||
*May be patchy/multifocal. | *May be patchy/multifocal. | ||
*Multiple cystic spaces. | |||
===Microscopic=== | ===Microscopic=== | ||
Features: | Features: | ||
*Cell enlargement. | *Pancreatic duct lining cells jut into the duct lumen - papillomatous growth pattern. | ||
*Increased [[NC ratio]]. | *Cytology: | ||
*Nuclear crowding and [[nuclear pleomorphism|pleomorphism]]. | **Cell enlargement. | ||
* | ***Increased mucin production. | ||
*Mitotic activity. | **Nuclear changes: | ||
* | ***Increased [[NC ratio]]. | ||
***Nuclear crowding and [[nuclear pleomorphism|pleomorphism]]. | |||
**Mitotic activity. | |||
Note: | |||
*No ovarian type stroma underneath (as seen in mucinous tumours). | |||
DDx: | DDx: | ||
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*[[Invasive ductal carcinoma of the pancreas]]. | *[[Invasive ductal carcinoma of the pancreas]]. | ||
===Classification IMPT=== | ====Classification IMPT==== | ||
Commonly classified by the duct involvement:<ref name=pmid20397268>{{Cite journal | last1 = Ikeuchi | first1 = N. | last2 = Itoi | first2 = T. | last3 = Sofuni | first3 = A. | last4 = Itokawa | first4 = F. | last5 = Tsuchiya | first5 = T. | last6 = Kurihara | first6 = T. | last7 = Ishii | first7 = K. | last8 = Tsuji | first8 = S. | last9 = Umeda | first9 = J. | title = Prognosis of cancer with branch duct type IPMN of the pancreas. | journal = World J Gastroenterol | volume = 16 | issue = 15 | pages = 1890-5 | month = Apr | year = 2010 | doi = | PMID = 20397268 PMC = 2856831 | URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2856831/}}</ref> | |||
#Main duct type. | |||
#*Commonly associated with invasive carcinoma. | |||
#Branch duct type. | |||
#*Less commonly associated with invasive carcinoma. | |||
=====Behaviour - Khalifa===== | |||
*Adenoma. | *Adenoma. | ||
*Borderline mucinous tumour. | *Borderline mucinous tumour. | ||
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Notes: | Notes: | ||
*Borderline tumours are rare. | *Borderline tumours are rare. | ||
*If intralobular dilated ducts... carcinoma. | |||
*Any margin with mucin cells in thought to be badness! | |||
* | |||
==Solid pseudopapillary tumour== | ==Solid pseudopapillary tumour== | ||