Intraductal papillary mucinous neoplasm

Intraductal papillary mucinous neoplasm
Updated: 03/26/2019
© Jun Wang, MD, PhD

General features
  • Intraductal epithelial neoplasm of mucin producing cells
  • Arising in main pancreatic duct or its branches
  • Benign or malignant
  • Classified based on highest degree of cytoarchitectural atypia and invasiveness
  • More common in men age 60+ at head of pancreas
  • Risk factor for pancreatic cancer
  • Associated with Peutz-Jegher syndrome
Clinical presentations
  • Epigastric pain, weight loss, jaundice, diabetes, pancreatitis
Key pathological features
  • Papillary growth of mucinous cells with duct dilatation (cyst formation), and dysplasia
  • Main duct involvement: Usually diffusely dilated, tortuous and irregular duct filled with mucin; higher risk of high grade dysplasia and malignancy
  • Branch duct involvement: Multicystic, grape-like structures filled with tenacious mucin; cyst walls usually thin with flat or papillary lining; cysts separated by normal pancreas
Treatment
  • Surgery for main duct involvement
  • Follow up or resection for branch duct involvement


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