Pancreatic ductal adenocarcinoma concomitant with intraductal papillary mucinous neoplasm: a report of 8 cases
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CASE REPORT
Pancreatic ductal adenocarcinoma concomitant with intraductal papillary mucinous neoplasm: a report of 8 cases Koichiro Mandai • Koji Uno • Kenjiro Yasuda
Received: 12 February 2013 / Accepted: 28 April 2013 / Published online: 12 May 2013 Ó Springer Japan 2013
Abstract Branch-duct intraductal papillary mucinous neoplasm (BD-IPMN) is recognized as a risk factor for pancreatic ductal adenocarcinoma (PDAC) that is unrelated to the malignant transformation of IPMN. We experienced 8 cases of resected PDAC concomitant with IPMN from March 1988 to December 2012, and 7 patients had [2 risk factors, including IPMN, for pancreatic cancer. Seven of the IPMNs were \30 mm in size, while none had mural nodules. Four cases of PDAC were detected during the follow-up period for BD-IPMN. Neither magnetic resonance cholangiopancreaticography nor contrast-enhanced computed tomography performed 5 months prior to the detection of PDAC resulted in its early detection in 2 cases. The clinical features of the 8 cases indicate that particular attention is required for patients with [1 risk factor, in addition to IPMN, for pancreatic cancer. A shorter interval of surveillance than that suggested by the international consensus guidelines 2012 is required, even if the IPMNs are small, for the early detection of PDAC. Keywords
IPMN PDAC Cancer Pancreas
Introduction Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are histologically classified as hyperplasia,
K. Mandai (&) K. Uno K. Yasuda Department of Gastroenterology, Kyoto Second Red Cross Hospital, 355-5 Haruobi-cho, Kamigyo-ku, Kyoto 602-8026, Japan e-mail: [email protected]; [email protected]
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adenoma, or carcinoma and are classified into 1 of 3 types—main-duct IPMN (MD-IPMN), branch-duct IPMN (BD-IPMN), or mixed type—based upon the results of imaging studies and/or histological analysis. According to the international consensus guidelines 2012 for the management of IPMN and mucinous cystic neoplasms of the pancreas, surgical resection is strongly recommended in patients with MD-IPMN because of a high frequency of malignancy (mean frequency 61.6 %). In contrast, the frequency of malignancy in resected BD-IPMN is much lower (mean frequency 25.5 %), and BD-IPMN without malignant signs, such as the presence of mural nodules and positive cytology, can be observed without immediate resection [1]. Some reports suggest an increased incidence of pancreatic ductal adenocarcinoma (PDAC) in patients with BD-IPMN that is unrelated to the malignant transformation of IPMN, and that the frequency of detection of PDAC during the follow-up period for BD-IPMN is 2.0–9.2 % [2– 5]. Clinical guidelines for pancreatic cancer from the Japan Pancreas Society suggest that 1 risk factor for pancreatic cancer is IPMN in addition to a family history of pancreatic cancer, hereditary pancreatic cancer syndrome, diabetes mellitus, obesity, chronic pancreatitis, hereditary pancreatitis, and smoking [6]. We experienced 8 cases of resected PDAC concomitant with IPMN f
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