Intraductal neoplasms of the pancreas
- VernacularTitle:Нойр булчирхайн сувганцар доторх өмөн
- Author:
Toru Furukawa
- Publication Type:journal article
- From:Innovation
2014;8(4):122-123
- CountryMongolia
- Language:English
-
Abstract:
Intraductal neoplasms of the pancreas are the second most common exocrine
pancreatic tumors trailing the pancreatic ductal adenocarcinoma. They show
distinctive clinical and pathological features, which physicians and surgeons
ought to know for proper management of patients developing the neoplasms.
Intraductal neoplasms of the pancreas are classified into intraductal papillary
mucinous neoplasms (IPMNs) and intraductal tubulopapillary neoplasms (ITPNs).
IPMNs are characterized by dilated ducts filled with mucus. The dilated duct is
lined by neoplastic cells growing papillary and secreting abundant mucin. The
neoplastic cells show varying grades of atypia from low-grade to high-grade.
Some of IPMNs become invasive and result in poor prognosis. Papillae composed
of neoplastic cells show various complex shapes that are classified into four
types, namely, gastric, intestinal, pancreatobiliary, or oncocytic. These types
of IPMN are associated with clinicopathological features including prognosis.
When IPMNs become invasive, an invasive component may show features of a
mucinous colloidal carcinoma or a desmoplastic tubular carcinoma. Molecular
characterization may show somatic mutations of GNAS, KRAS, and RNF43.
ITPN is characterized by a clogging tumor in the dilated main pancreatic duct
without mucus. It is composed of high-grade dysplastic columnar cells showing
complex tubulopapillary architecture. ITPN often extends into connecting
branch ducts and may involve the entire pancreatic ductal system. The neoplasm
occasionally shows invasion and metastasis, which can result in poor prognosis.
Molecular characterization may show a somatic mutation of PIK3CA and
activation of AKT.
Patients with intraductal neoplasms often have abdominal pain that is caused by
acute or chronic pancreatitis associated with obstruction of pancreatic duct by
thick mucus or a tumor itself. Detailed imaging studies are necessary for detecting
signs of high-grade or invasive lesions, which determines surgical indications.
A biopsy of intraductal neoplasms is possible via duodenal papilla, and is often
useful for determining grade of neoplasms. Complete resection is necessary for
curing the disease, which sometimes necessitates total pancreatectomy. When
pancreatoduodenectomy or distal pancreatomy is performed, recurrence or a
metachronous development of the neoplasm in a remnant pancreas may occur,
so that a careful postoperative follow-up is necessary.
