Branch-Type Intraductal Papillary Mucinous Neoplasms

Excerpt

Intraductal papillary mucinous neoplasms (IPMNs) have become an increasingly recognized entity since first being described in 1982 [1]. However, the natural history (particularly of branch duct tumors) is still unknown, and management remains controversial [2]. Nagai et al. [3] describe the outcome of a 22-year experience with 72 consecutive patients who have undergone surgical resection for IPMNs. The aim was to determine the appropriate management of those with a preoperative diagnosis of IPMN. The authors [3] concluded that all patients who were surgically fit should undergo resection. The basis of this conclusion was that of the 15 patients with main duct IPMN 10 had invasive carcinoma and the remaining 5 had carcinoma in situ, and the corresponding figures for the 57 patients with branch duct or mixed-type IPMN were 20 and 9, respectively. Thus, the overall incidence of premalignant or malignant change in the whole series was 61% (44/72). Patients with branch duct or mixed duct lesions were subsequently analyzed for risk factors that could be used preoperatively to determine malignancy. Although a tumor size of > 30 mm was found to be an independent predictor of malignancy, 7 of the 25 patients who had tumors < 30 mm had underlying premalignant or frankly malignant histology. The authors [3] further supported their conclusions by showing reduced survival for those with invasive disease and the fact that this series was completed without severe complication (25% morbidity) and no mortality. …