title: Clinicopathological features of malignant intraductal papillary mucinous tumors of the pancreas: the differential diagnosis from benign entities.
abstract: BACKGROUND
  The accurate differential diagnosis of malignant intraductal papillary mucinous tumors (IPMTs) of the pancreas from benign IPMTs remains unclear.
  
  
  OBJECTIVE
  Predictive factors for differentiating malignant IPMTs from benign IPMTs can be documented.
  
  
  METHODS
  Retrospective study (1999-2003).
  
  
  METHODS
  Wakayama Medical University Hospital, Wakayama, Japan.
  
  
  METHODS
  Twenty-seven consecutive patients with IPMTs (11 with adenoma, 3 with dysplasia, 5 with adenocarcinoma, and 8 with invasive adenocarcinoma) who underwent surgery were retrospectively analyzed in terms of clinicopathological features.
  
  
  METHODS
  Clinical data, preoperative imaging findings, cytology, and tumor marker level, including carcinoembryonic antigen (CEA) and carbohydrate antigen (CA19-9), in serum and pure pancreatic juice.
  
  
  RESULTS
  In preoperative imaging findings, the mean tumor size for the malignant IPMT group (81 +/- 18 mm) was significantly larger than that for the benign IPMT group (31 +/- 4 mm) (P =.002). The mean mural nodule size for the malignant IPMT group (9.8 +/- 4.4 mm) was significantly larger than that for the benign IPMT group (3.3 +/- 5.7 mm) (P =.002). The CEA levels in pure pancreatic juice in the malignant IPMT group (3051 +/- 7556 ng/mL) were significantly higher than in the benign IPMT group (41 +/- 80 ng/mL) (P =.003), although no significant differences in cytologic analyses and CA19-9 levels in pure pancreatic juice were found between the 2 groups.
  
  
  CONCLUSIONS
  Our findings suggest that tumor size larger than 30 mm, mural nodule size larger than 5 mm, and CEA levels higher than 110 ng/mL in pure pancreatic juice were predictive factors for diagnosis of malignant IPMTs.
authors.affiliation: Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Kawai
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Uchiyama
authors.forename: Masaji
authors.initials: M
authors.lastname: Tani
authors.forename: Hironobu
authors.initials: H
authors.lastname: Onishi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kinoshita
authors.forename: Masaki
authors.initials: M
authors.lastname: Ueno
authors.forename: Takashi
authors.initials: T
authors.lastname: Hama
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yamaue
mesh_terms: D000236:Adenoma / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D000368:Aged; D001707:Biopsy, Needle; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000379:methods; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D011183:Postoperative Complications / Q000401:mortality; D011300:Preoperative Care; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome