title: Intraductal papillary mucinous neoplasms.
abstract: OBJECTIVE
  Our understanding of intraductal papillary mucinous neoplasm (IPMN) of the pancreas has remarkably grown within the last decade; nonetheless there is still an ongoing controversy if the majority of these potentially malignant neoplasms need to be resected or if observation in a subset is well tolerated.
  
  
  RESULTS
  Novel cyst fluid biomarkers, like Gnas mutations or mab DAS-1, could play a pivotal role in the distinction of IPMN vs. other cystic lesions, in the sub-classification of IPMN and in the detection of IPMN with high-grade dysplasia or invasive cancer. Other recent studies focused on natural history of minimal- and extensive-mixed IPMN and the safety of the 2012 AIP guidelines. Small series also described that observation can be an option in selected frail patients with MD-IPMN. Further, data from a large European multicenter study analysis indicated that patients with IPMN do not have an increased frequency of extrapancreatic malignancies.
  
  
  CONCLUSIONS
  Increasing knowledge about the nature of IPMN and their subtypes has resulted in an individualized approach in diagnosis and treatment. Owing to the availability of accurate diagnostic instruments, timing and indication for pancreatic resection have become more selective, sparing patients with harmless IPMN from major surgery.
authors.affiliation: aDepartment of Surgery, Medical University Vienna, Vienna, Austria bDepartment of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA.
authors.forename: Klaus
authors.initials: K
authors.lastname: Sahora
authors.forename: Carlos
authors.initials: C
authors.lastname: Fernández-del Castillo
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000276:immunology / Q000378:metabolism / Q000473:pathology*; D021441:Carcinoma, Pancreatic Ductal / Q000276:immunology / Q000378:metabolism / Q000473:pathology*; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D055262:Mucin-2 / Q000096:biosynthesis / Q000276:immunology / Q000378:metabolism*; D010183:Pancreatic Ducts / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000276:immunology / Q000378:metabolism / Q000473:pathology*; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011379:Prognosis; D018571:Sentinel Surveillance
chemical_list: C524625:MUC2 protein, human; D055262:Mucin-2