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Abstract
Background/Aims
Intraductal papillary mucinous neoplasm (IPMN) of the pancreas has a favorable prognosis, but seems to be associated with a high incidence of extrapancreatic tumors. The purpose of this study was to evaluate the incidence and clinicopathological features of extrapancreatic tumors associated with IPMN.
Methods
Thirty-seven patients with IPMN of the pancreas, confirmed by surgical resection and typical findings of endoscopic ultrasonography and CT imaging between October 1, 1998 and August 31, 2006 were included. Seventeen patients were diagnosed with surgical resection and biopsy, and others by typical imaging findings of IPMN. These patients were examined for the development of extrapancreatic tumors.
Results
Of 37 patients with IPMN, 14 (38%) had 18 extrapancreatic tumors, and 10 (27%) had 13 extrapancreatic malignancies. Five, six, and two extrapancreatic malignancies had diagnosed before during, and after the diagnosis of IPMN. Gastric adenocarcinoma (3 patients, 23%) and colorectal carcinoma (3 patients, 23%) were the most common neoplasms. Other extrapancreatic tumors included lung cancer (n=2), prostatic cancer (n=1), renal cell carcinoma (n=1), chol-angiocelluar carcinoma (n=1), urinary bladder cancer (n=1), and gallbladder cancer (n=1), respectively. As benign tumor, there were two gallbladder adenoma, one gastric adenoma, one colonic adenoma and one benign ovarian cystic neoplasm, respectively.
Conclusions
IPMN is associated with high incidence of extrapancreatic tumors, particularly gastric and colorectal neoplasms. Upper gastrointestinal endoscopy and colonoscopy should be done, and systemic surveillance for the possible occurrence of other tumors may allow early detection of extrapancreatic tumor in patients with IPMN.
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Table 1.
Patients Characteristics
| Characteristic | No. of value |
|---|---|
| No. of patients, n | 37 |
| Gender, n (male/female) | 17/20 |
| Mean age, yr (range) | 65.7 (31-90) |
| Follow up duration, mo (range) | 17.5 (1-76) |
| Symptomatic patients, n (%) | 27 |
| Abdominal pain | 22 (44) |
| Abdominal mass | 4 (8) |
| Acute pancreatitis | 7 (14) |
| Jaundice | 3 (6) |
| Nausea/vomiting | 10 (20) |
| Weight loss | 4 (8) |
| Type of IPMN, n (%) | |
| Main duct | 8 (22) |
| Branch duct | 21 (56) |
| Combined | 8 (22) |
| Location, n (%) | |
| Head | 31 (84) |
| Body-tail | 6 (16) |
| WBC count, cells/mm3 | 6,981±2,423∗ |
| CEA, ng/mL | 14.8±48.1∗ |
| CA19-9, U/mL | 39.2±73.1∗ |
Table 3.
Clinicopathologic Feature of Intraductal Papillary Mucinous Neoplasm Patients with and without Extrapancreatic Tumors
| With other tumor | Without other tumor | p value | |
|---|---|---|---|
| Gender, n (male/female) | 14 (9/5) | 23 (8/15) | NS |
| Age, yr | 69.9±9.5∗ | 62.8±15.0∗ | NS |
| Pathology of IPMN, n | NS | ||
| Benign | 10 | 18 | |
| Malignant | 4 | 5 | |
| Type of IPMN, n | NS | ||
| Main duct | 3 | 5 | |
| Branch duct | 7 | 14 | |
| Combined | 4 | 4 | |
| Follow-up period, mo | 16.1±16.0∗ | 19.9±25.1∗ | NS |
| CEA, ng/mL | 25.9±74.2∗ | 6.8±11.2∗ | NS |
| CA19-9, U/mL | 75.3±113.4∗ | 19.1±22∗ | NS |
Table 2.
Number of Extrapancreatic Malignancy in Patients with Intraductal Papillary Mucinous Neoplasm (n=37)
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