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 exocrinepancreatic tumors trailing the pancreatic ductal adenocarcinoma. They showdistinctive clinical and pathological features, which physicians and surgeonsought to know for proper management of patients developing the neoplasms.Intraductal neoplasms of the pancreas are classified into intraductal papillarymucinous neoplasms (IPMNs) and intraductal tubulopapillary neoplasms (ITPNs).IPMNs are characterized by dilated ducts filled with mucus. The dilated duct islined by neoplastic cells growing papillary and secreting abundant mucin. Theneoplastic cells show varying grades of atypia from low-grade to high-grade.Some of IPMNs become invasive and result in poor prognosis. Papillae composedof neoplastic cells show various complex shapes that are classified into fourtypes, namely, gastric, intestinal, pancreatobiliary, or oncocytic. These typesof IPMN are associated with clinicopathological features including prognosis.When IPMNs become invasive, an invasive component may show features of amucinous colloidal carcinoma or a desmoplastic tubular carcinoma. Molecularcharacterization may show somatic mutations of GNAS, KRAS, and RNF43.ITPN is characterized by a clogging tumor in the dilated main pancreatic ductwithout mucus. It is composed of high-grade dysplastic columnar cells showingcomplex tubulopapillary architecture. ITPN often extends into connectingbranch ducts and may involve the entire pancreatic ductal system. The neoplasmoccasionally shows invasion and metastasis, which can result in poor prognosis.Molecular characterization may show a somatic mutation of PIK3CA andactivation of AKT.Patients with intraductal neoplasms often have abdominal pain that is caused byacute or chronic pancreatitis associated with obstruction of pancreatic duct bythick mucus or a tumor itself. Detailed imaging studies are necessary for detectingsigns of high-grade or invasive lesions, which determines surgical indications.A biopsy of intraductal neoplasms is possible via duodenal papilla, and is oftenuseful for determining grade of neoplasms. Complete resection is necessary forcuring the disease, which sometimes necessitates total pancreatectomy. Whenpancreatoduodenectomy or distal pancreatomy is performed, recurrence or ametachronous development of the neoplasm in a remnant pancreas may occur,so that a careful postoperative follow-up is necessary.
