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Intraductal papillary mucinous tumour (view source)
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'''Intraductal papillary mucinous tumour''', abbreviated '''IPMT''', is an uncommon tumour of the [[pancreas]]. | |||
==General== | |||
*Morphologically and biologically distinct from ductal adenocarcinoma, mucinous cystic tumour and ductal papillary hyperplasia. | |||
*Prognosis: | |||
**Favourable if caught early; not much different than ductal adenocarcinoma if caught late.<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> | |||
**Dependent what is involved:<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> | |||
***Main duct (bad prognosis). | |||
***Branch (good prognosis). | |||
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. | |||
====Epidemiology==== | |||
*~1% of all exocrine pancreatic tumours. | |||
*More common in males. | |||
*Mean age at presentation 62 years. | |||
*60-80% occur in the head of the pancreas. | |||
*Average size 4 cm. | |||
===Classification of 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===== | |||
*Adenoma. | |||
*Borderline mucinous tumour. | |||
*Carcinoma. | |||
Notes: | |||
*Borderline tumours are rare. | |||
*If intralobular dilated ducts... carcinoma. | |||
*Any margin with mucin cells in thought to be badness! | |||
==Gross== | |||
*May be patchy/multifocal. | |||
*Multiple cystic spaces. | |||
==Microscopic== | |||
Features: | |||
*Pancreatic duct lining cells jut into the duct lumen - papillomatous growth pattern. | |||
*Cytology: | |||
**Cell enlargement. | |||
***Increased mucin production. | |||
**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: | |||
*[[PanIN]]. | |||
*[[Invasive ductal carcinoma of the pancreas]]. | |||
*Intra-ampullary papillary-tubular neoplasm -- see ''[[ampulla of Vater]]''. | |||
==See also== | |||
*[[Pancreas]]. | |||
==References== | |||
{{Reflist|1}} | |||
[[Category:Pancreas]] | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||