title: Analysis of clinicopathological features and predictors of malignancy in intraductal papillary mucinous neoplasms of the pancreas.
abstract: OBJECTIVE
  Intraductal papillary mucinous neoplasms (IPMNs) are increasingly recognized, but it is very difficult to evaluate accurately the malignancy of these neoplasms by modern imaging. We reviewed our experience in order to elucidate predictors of tumor malignancy, invasiveness, and outcome.
  
  
  METHODS
  The clinicopathological features and surgical outcomes of 57 patients with IPMNs who underwent surgery in Nagoya University Hospital were analyzed.
  
  
  RESULTS
  The histological diagnosis was adenoma in 40, borderline in 1, carcinoma in situ (CIS) in 7, and invasive carcinoma in 9 patients. Patients with invasive carcinomas had significantly shorter survival rates than patients with benign IPMNs or CIS (p < 0.0001). Multivariate analyses revealed that the main duct or the combined type was significantly predictive of malignancy, and both main duct or combined type and diabetes mellitus were associated significantly with invasive carcinoma.
  
  
  CONCLUSIONS
  IPMNs generally grow slowly, but have a malignant potential that warrants radical surgical treatment when the tumor component invades the parenchyma. Our results suggest that the above factors should be considered in surgical management. The main duct type of IPMN or IPMN with mural nodules is potentially malignant or invasive. Therefore, radical operative management is indicated in these IPMNs.
authors.affiliation: Department of Surgery II, Nagoya University, Graduate School of Medicine Nagoya, Japan. fjt@med.nagoya-u.ac.jp
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Fujii
authors.forename: Tadao
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Naohito
authors.initials: N
authors.lastname: Kanazumi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sugimoto
authors.forename: Shuji
authors.initials: S
authors.lastname: Nomoto
authors.forename: Soichiro
authors.initials: S
authors.lastname: Inoue
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Nagasaka
authors.forename: Shin
authors.initials: S
authors.lastname: Takeda
authors.forename: Akimasa
authors.initials: A
authors.lastname: Nakao
mesh_terms: D000368:Aged; D002278:Carcinoma in Situ / Q000473:pathology / Q000601:surgery; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology* / Q000601:surgery; D002291:Carcinoma, Papillary / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies