title: [Presentation, treatment and prognosis of intraductal papillary mucinous neoplasm].
abstract: Intraductal papillary mucinous neoplasms (IPMNs) are rare tumours rising from the pancreatic duct epithelium. They are characterized by intraductal papillary growth and thick mucin secretion; mucin fills the Wirsung and/or branch pancreatic ducts and may cause ductal dilatation. IPMNs are classified into three types, according to the site of involvement: main duct type, branch duct type, and combined type. Most branch type IPMNs are benign, while the other two types are frequently malignant. Recent advances in diagnostic imaging have led to an increased frequency of diagnosis of IPMNs, but the clinical features of them can range broadly from benign, borderline, and malignant non-invasive to invasive lesions, and their management has not yet been clearly defined. The most of patients are asymptomatic. The possibility of malignancy is increased in cases which large mural nodules are presented. Presence of a large branch type IPMN and marked dilatation of the main duct indicate the existence of adenoma. Not infrequently, synchronous or metachronous malignancies may be developed in various organs. Endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasonography (EUS), intraductal ultrasonography, and magnetic resonance cholangiopancreatography (MRCP) are the most valuable imaging techniques for diagnosis of these lesions. Prognosis is excellent after complete resection of benign and non-invasive malignant IPMNs. Total pancreatectomy should be reserved for patients with resectable but extensive IPMN involving the whole pancreas; its benefits must be balanced against perioperative risks.
authors.affiliation: Dipartimento di Scienze Chirurgiche, Unità di Chirurgia Digestiva, Università Cattolica del Sacro Cuore, Roma, Italia. marcoprmed@libero.it
authors.forename: Marco Pericoli
authors.initials: MP
authors.lastname: Ridolfini
authors.forename: Stavros
authors.initials: S
authors.lastname: Gourgiotis
authors.forename: Sergio
authors.initials: S
authors.lastname: Alfieri
authors.forename: Dario
authors.initials: D
authors.lastname: Di Miceli
authors.forename: Fabio
authors.initials: F
authors.lastname: Rotondi
authors.forename: Futura
authors.initials: F
authors.lastname: Limongelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Quero
authors.forename: Alberto
authors.initials: A
authors.lastname: Larghi
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Cazzato
authors.forename: Nunzia
authors.initials: N
authors.lastname: Martella
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Doglietto
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000145:classification / Q000175:diagnosis / Q000601:surgery; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000145:classification / Q000175:diagnosis / Q000601:surgery; D003937:Diagnosis, Differential; D004108:Dilatation, Pathologic / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts; D010190:Pancreatic Neoplasms / Q000145:classification / Q000175:diagnosis / Q000601:surgery; D011379:Prognosis