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Colloid carcinoma or mucinous noncystic carcinoma arising from an IPMN. (a) Large mucin “lakes” representing invasive adenocarcinoma replacing normal pancreatic parenchyma (residual parenchyma in the left edge of the picture). Clusters of tumor epithelial cells are seen “floated” in the mucin, as seen in higher magnification in panel (b).
Source publication
Intraductal papillary mucinous neoplasm (IPMN) is a cystic tumor of the pancreas. The etiology is unknown, but increasing evidence suggests the involvement of several tumorigenesis pathways, including an association with hereditary syndromes. IPMN occurs more commonly in men, with the mean age at diagnosis between 64 and 67 years old. At the time o...
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Background
The risk of developing pancreatic cancer is uncertain in patients with clinically suspected branch duct intraductal papillary mucinous neoplasm (BD-IPMN) based on the “high-risk stigmata” or “worrisome features” criteria proposed in the 2012 international consensus guidelines (“Fukuoka criteria”).
Methods
Retrospective case series invol...
Intraductal papillary mucinous neoplasms (IPMNs) display diverse macroscopic, histological, and immunohistochemical characteristics with typical morphological appearance in magnetic resonance imaging. Depending on those, IPMNs may show progression into invasive carcinomas with variable frequency. Overall, IPMN-associated invasive carcinomas are fou...
We report a rare case of double Intraductal Papillary Muci-nous Neoplasm with multiple foci of adenocarcinoma origi-nating from duodenal and gastric heterotopic pancreatic tis-sue, associated with gastric duplication and intestinal mal-rotation. Only few cases of Intraductal Papillary Mucinous Neoplasm arising within ectopic pancreas have been repo...
Aim:
To evaluate the association between the interleukin 1β (IL-1β) polymorphisms and the pancreatic neuroendocrine tumor (pNET) development.
Methods:
A case-control study was conducted analyzing IL-1β polymorphisms using germline DNA collected in a population-based case-control study of pancreatic cancer (51 pNET cases, 85 pancreatic ductal ade...
Citations
... Gasztrikus metaplázia körülbelül 98%-ban mellékduktusz-érintettségű IPMN-nél fordul elő (57), morfológiájára a magas hengerhámsejtek jellemzőek, apikális elhelyezke-désű mucinnal, bazális orientációjú sejtmagokkal (58). Immunhisztokémiai vizsgálattal MUC5AC-és fokális MUC6-pozitivitás a típusos (59). ...
... A hám általában low grade diszpláziát mutat, a malignizálódási rizikó alacsony, míg az invazív eseteket a rendkívül rossz prognózisú tubuláris adenokarcinóma alkotja (59). A duktuszrendszer foveoláris metapláziája gyakran társul duodenális peptikus fekéllyel, valamint szűkületeket, krónikus fekélyeket és sipolyokat okozó Crohn-betegséggel (58). ...
... Az intesztinális fenotípus inkább MD-típusú IPMN mellett fordul elő (73%) (57). Szövettanilag villózus papillákat alkotó magas hengerhám jellemzi, kehelysejtekkel és fokozott mucintermeléssel (58). Immunhisztokémiai reakciókat végezve MUC2-és CDX2-pozitivitás dominál, genotipizálással GNASés SMAD1/5/8 mutációk gyakran azonosíthatóak (60). ...
In an increasingly aging Western society, the treatment of the malignant diseases became the greatest challenge of medicine in the 21st century. Among these, pancreatic ductal adenocarcinoma (PDAC) is of particular interest which, in spite of modern oncology treatments, is a malignancy with an unfavorable prognosis. Underlying the poor survival rates, relatively late-stage recognition, limitations of surgical removal, and ineffective oncological treatments can be mentioned. Its importance is further enhanced by its growing incidence. As a consequence of these reasons, there is an increasing effort for the early detection of invasive tumors, the central part of which is the detection and clinical addressing of precancerous conditions in the pancreas. Of these, intraductal papillary mucinous neoplasia (IPMN) has a paramount importance. In this review, we present the latest evidence-based knowledge of the etiological factors, epidemiological features, pathomorphological manifestations, most up-to-date diagnosis and treatment of IPMN.
... Gasztrikus metaplázia körülbelül 98%-ban mellékduktusz-érintettségű IPMN-nél fordul elő (57), morfológiájára a magas hengerhámsejtek jellemzőek, apikális elhelyezke-désű mucinnal, bazális orientációjú sejtmagokkal (58). Immunhisztokémiai vizsgálattal MUC5AC-és fokális MUC6-pozitivitás a típusos (59). ...
... A hám általában low grade diszpláziát mutat, a malignizálódási rizikó alacsony, míg az invazív eseteket a rendkívül rossz prognózisú tubuláris adenokarcinóma alkotja (59). A duktuszrendszer foveoláris metapláziája gyakran társul duodenális peptikus fekéllyel, valamint szűkületeket, krónikus fekélyeket és sipolyokat okozó Crohn-betegséggel (58). ...
... Az intesztinális fenotípus inkább MD-típusú IPMN mellett fordul elő (73%) (57). Szövettanilag villózus papillákat alkotó magas hengerhám jellemzi, kehelysejtekkel és fokozott mucintermeléssel (58). Immunhisztokémiai reakciókat végezve MUC2-és CDX2-pozitivitás dominál, genotipizálással GNASés SMAD1/5/8 mutációk gyakran azonosíthatóak (60). ...
Az egyre inkább elöregedő nyugati társadalomban a 21. szá-zadi medicina legnagyobb kihívását a rákos megbetegedések megfelelő kezelése jelenti. Ezek közül is kiemelkedő jelentő-ségű a pankreatikus duktális adenokarcinóma (PDAC), mely a legmodernebb onkológiai kezelések ellenére is rendkívül kedvezőtlen prognózisú malignitás. A rossz túlélési mutatók hátterében a viszonylag késői stádiumban történő felismerés, a sebészi eltávolítás limitációi és az onkológiai kezelések nem megfelelő hatékonysága állnak. Jelentőségét tovább növeli egyre emelkedő incidenciája is. Ezen okok következménye-ként egyre erőteljesebb a törekvés az invazív daganatok korai felismerésére, aminek központi részét képezi a hasnyálmi-rigy daganatmegelőző állapotainak észlelése és megfelelő klinikai ellátása is. Ezek közül is kiemelkedő fontosságú az intraduktális papilláris mucinózus neoplázia (IPMN), mely a hasnyálmirigy leggyakoribb cisztikus prekancerózus állapo-ta. Ezen összefoglaló tanulmányban ismertetjük a legfrissebb evidenciaalapú ismereteket az IPMN etiológiai faktorairól, epi-demiológiai jellegzetességeiről, patomorfológiai megjelenési formáiról, illetve korszerű diagnosztikájáról és kezeléséről. Magy Onkol 65:223-230, 2021 Kulcsszavak: pankreatikus intraduktális neoplázia, daganat-megelőző állapotok, hasnyálmirigyrák, IPMN In an increasingly aging Western society, the treatment of the malignant diseases became the greatest challenge of medicine in the 21st century. Among these, pancreatic duc-tal adenocarcinoma (PDAC) is of particular interest which, in spite of modern oncology treatments, is a malignancy with an unfavorable prognosis. Underlying the poor survival rates, relatively late-stage recognition, limitations of surgical removal, and ineffective oncological treatments can be mentioned. Its importance is further enhanced by its growing incidence. As a consequence of these reasons, there is an increasing effort for the early detection of invasive tumors , the central part of which is the detection and clinical addressing of precancerous conditions in the pancreas. Of these, intraductal papillary mucinous neoplasia (IPMN) has a paramount importance. In this review, we present the latest evidence-based knowledge of the etiological factors, e pidemiological features, pathomorphological manifestations , most up-to-date diagnosis and treatment of IPMN. Németh K, Budai A. All you should know about intraductal papillary mucinous neoplasm (IPMN). Magy Onkol 65:223-230, 2021
... Patients with a type of neoplastic pancreatic cyst, intraductal papillary mucinous neoplasm of the pancreas (IPMN) can develop an invasive malignancy called IPMN-associated adenocarcinoma. These patients can also develop ductal adenocarcinoma 22 . Smoking is the most common cause of pancreatic cancer. ...
Background: Recent incidence trends of pancreatic cancers were reviewed by demographics and histologic type to observe any new findings.
Methods: Data was used from the Surveillance, Epidemiology, and End Results (SEER) registry 18 (2000-2017) and it underwent temporal trend analysis. Pancreatic cancer incidence rates were reported based on histological subtype and demographics.
Results: The incidence rate of white males increased significantly during 2000-2017 (annual percent change (APC) = 3.5%) compared to previously reported APCs. The incidence of white females grew from an APC of 1.29% to 2.9%. Rates among black ethnicity increased with an APC of 4.2%. Rates among Hispanics and other ethnicities also showed increment. The rates for ductal adenocarcinoma showed a positive trend in all races, with the APC ≥ 6 % for females and APC ≥ 6.5 % for males. The rates of non-secretory endocrine tumors showed a decline in both genders of all five races in recent years after showing an initial positive trend till 2010. Rates for pancreatic adenocarcinoma continued to rise in all ethnicities from 2000-2017. Interestingly, there was a rise in carcinoid type pancreatic neuroendocrine tumors (PNETs) in all ethnicities. Cumulatively, males had a higher incidence than females; male to female Incidence Risk Ratio (IRRs) was 1.32. The IRR was > 1 for age groups ≥ 35 years. The male to female IRRs was less than 1 for cystic adenocarcinoma, secretory endocrine, and solid pseudopapillary carcinomas (IRR = 0.5, 0.9, and 0.2 respectively, confidence intervals 0.4–0.6 and 0.9-1.3, 0.2–0.3, respectively).
Conclusion: Pancreatic cancer incidence continued to rise in the years 2000-2017. However, incidence differed by demographics and histologic type. Interestingly, recent years discerned a rise in PNETs (carcinoid type) which has not been reported previously.
... Preoperative imaging using CT or MRI is unable to differentiate ICPN from Carcinoma of gall bladder. The features described in view of ICPN are: [1] intramucosal, [2] preinvasive neoplastic (dyspla-stic), [3] mass forming: exophytic (papillary or polypoid), [4] size more than 1.0 cm, [5] compact, and [6] distinct from the neighboring mucosa. However, ICPN is a novel concept, and the diagnostic features remain uncertain [27] . ...
... Preoperative imaging using CT or MRI is unable to differentiate ICPN from Carcinoma of gall bladder. The features described in view of ICPN are: [1] intramucosal, [2] preinvasive neoplastic (dyspla-stic), [3] mass forming: exophytic (papillary or polypoid), [4] size more than 1.0 cm, [5] compact, and [6] distinct from the neighboring mucosa. However, ICPN is a novel concept, and the diagnostic features remain uncertain [27] . ...
We present a case report of a 57year old lady who presented with complaints of right sided upper abdominal pain. The patient was initially diagnosed with carcinoma gall bladder(CAGB) by CECT Abdomen and PET CT imaging studies. Intra cholecystic papillary tubular neoplasm of the gall bladder(ICPN) was diagnosed after histopathological examination of the radical cholecystectomy specimen. ICPN can be managed with a cholecystectomy if the diagnosis is known pre operatively as the prognosis for ICPN is much better as compared with that for gallbladder adenocarcinoma.
... IPMNs are benign, premalignant, mucin-producing neoplasms within the pancreatic duct (main or branch ducts). The lining epithelium is tall columnar, with or without papillary projections, and can show gastric, intestinal, oncocytic or pancreaticobiliary differentiation [6]. IPMNs on histology do not have the distinctive sub-epithelial ovarian-type stroma, which differentiates them from mucinous cystic neoplasms of the pancreas [7]. ...
Undifferentiated carcinoma of the pancreas with osteoclast-like giant cells is a rare pancreatic tumor of unclear origin. This case reports a 72-year-old male with bloating and indigestion for about six years who was found to have a 5 cm laterally spreading ampullary mass and a 1.3 cm solid and cystic distal pancreas body mass on esophagogastroduodenoscopy (EGD) and endoscopic ultrasound (EUS). Histological examination of the pancreatic mass showed an undifferentiated carcinoma with osteoclast-like giant cells, contiguous with and apparently arising from an IPMN. Rare areas of glandular morphology within the invasive carcinoma, as well as patchy expression of epithelial markers and close physical association with an IPMN, clearly support an epithelial origin of this neoplasm and also suggest neoplastic progression from a preneoplastic ductal lesion to an invasive carcinoma, similar to the histogenesis of ductal-type pancreatic adenocarcinoma. Molecular analysis of the invasive carcinoma revealed mutations typical of pancreatic ductal carcinoma. Identical mutations were then identified within the intraductal mucinous neoplasm, consistent with origin of this rare pancreatic carcinoma subtype from IPMN.
... Currently, there are no well-established risk factors for IPMN development (2) but some have been linked it to genetic syndromes like familial adenomatous polyposis, Peutz-Jeghers and even Lynch syndrome (5,6). ...
Intraductal papillary mucinous neoplasm (IPMN) of the pancreas are pre neoplastic lesions defined by the World Health Organization as a grossly visible intraductal epithelial neoplasm that arises in the pancreatic ductal system, composed of mucin producing cells. The predisposing factor for their development as well as genetics are still largely unknown. Pathologists have a pivotal role in IPMN management since features like IPMN subtype, degree of atypia, margins status and presence or absence of an invasive component imply different patient management. In this article, we perform a review of the pathological features and molecular markers of IPMNs.
... These are the most common cystic lesions of the pancreas and result from in situ neoplastic cells that hypersecrete mucin, causing focal or diffuse cystic dilation of the main duct or side branches. Main duct intraductal papillary mucinous neoplasms (IPMNs) have higher risk of malignancy (with invasive carcinoma in up to 37%) compared to side-branch IPMNs (with various dysplasia or carcinoma in situ in up to 15%) [13]. They are T2 hyperintense and are best identified on MRCP (Fig. 16). ...
Few things in radiology are “pathognomonic” in their appearance or presentation. However, having an awareness of those findings which are specific to a certain entity is important when interpreting imaging studies. These classic findings can be identified with many imaging modalities, but no modality provides as many recognizable observations as an MRI. This results from the large variety of pulse sequences that provide high contrast resolution, prior to and following contrast administration. In this article, the most classically recognized abdominal findings are presented including the following: Liver: Cyst, hemangioma, focal nodular hyperplasia, hepatic adenoma, hemosiderosis, hepatocellular carcinoma. Spleen: Cyst, hemangioma, lymphangioma, hemosiderosis, Gandy–Gamna bodies. Biliary system: Biliary stones and choledocholithiasis, pneumobilia, choledochal cyst. Gallbladder: Adenomyomatosis, sludge, surgical clips in the gallbladder fossa. Pancreas: Pancreatic divisum, intraductal papillary mucinous neoplasm, pseudocyst, autoimmune pancreatitis, chronic pancreatitis, adenocarcinoma. Kidneys: Simple cyst, hemorrhagic cyst, renal sinus cyst, angiomyolipoma, solid mass.
... Main duct IPMNs have the highest risk of malignancy, with mean risk around 65% to 70%. Branch duct IPMNs (BD-IPMNs) have mean risk of malignancy around 25% (3), The presence of pancreatitis-like symptoms or mural nodule in BD-IPMN is associated with higher and faster malignant risk (7,8). ...
Mucinous cystic neoplasms (MCNs) and intraductal papillary mucinous neoplasms (IPMNs) are two well recognized entities of precursor cystic lesions of pancreatic duct adenocarcinoma. The characteristic features of MCNs are the lined mucinous epithelium with underlying ovarian-type stroma, but without communication with the ducts, while that for IPMNs are the communication with the ducts but without the underlying ovarian-type stroma. Here we report a case of MCN communicating with the main pancreatic duct in a 68-year-old woman. The initial radiographic diagnosis was pancreatic IPMN with main pancreatic involvement and this was also confirmed during gross examination. Histologically, the pancreatic cystic neoplasm was lined with mucinous epithelium with underlying ovarian-type of stroma. Immunohistochemical stains confirmed that the stroma cells were positive for ER, PR, alpha-inhibin and focally positive for CD10. The final pathologic diagnosis was pancreatic mucinous cystic neoplasm communicating with the main pancreatic duct. To the best of our knowledge, this is the second pathology confirmed case of MCN communicating with the main pancreatic duct. A careful gross examination and bivalvation of the main duct communicating with the cystic neoplasm helps render the correct diagnosis. If more cases are reported in the future, the MCN communicating with duct could become a new entity of pancreatic mucinous neoplasm.
... IPMN of the pancreas is an epithelial neoplasm of mucin producing cells arising in the main or branch ducts [31]. Based on cytoarchitectural atypia, IPMN is classified into low-and high-grade dysplasia [32]. ...
Annexins are a multigene family of calcium and phospholipid-binding proteins that play important roles in calcium signaling, cell motility, differentiation and proliferation. Our previous mass spectrometry-based proteomics study revealed that annexin A10 (ANXA10) was uniquely overexpressed in pancreatic CD24⁺ adenocarcinoma cells that were dissected from clinical PDAC tissues but was absent in CD24⁻ adjacent normal cells. The correlation between ANXA10 expression and the progression of pancreatic cancer remains unknown. In this study, we performed an immunostaining assay to evaluate ANXA10 expression in 155 primary human tissue specimens, including normal pancreas, chronic pancreatitis (CP), pancreatic adenocarcinoma (PDAC), pancreatic intraepithelial neoplasia (PanIN, the most important precursor of PDAC), and intraductal papillary mucinous neoplasm (IPMN). The immunostaining result showed that ANXA10 was significantly overexpressed in PanINs, IPMNs, and PDACs but negative in normal pancreas and the majority of chronic pancreatitis tissues. Statistical analysis revealed that ANXA10 expression was significantly associated with PDAC and its precursor lesions (p<0.0001). Abundant ANXA10 expression was predominantly present in pancreatic ductal epithelial cells of PanINs, IPMNs, and tumor cells of PDACs. Since PDAC develops through a series of PanINs which in turn arise from pancreatic ducts, the consistent overexpression of ANXA10 in ductal epithelial cells in PanINs and PDACs but negative in normal pancreatic ducts suggests that ANXA10 could serve as a potential marker indicating the presence of PDAC at its earliest precancerous stages. Double immunostaining of ANXA10 and CD24 showed that there was a large overlap between these two markers in PDAC and high-grade neoplasia lesions. The statistical analysis showed that the coexpression of ANXA10 and CD24 was significantly correlated with the progression of pancreatic precursor lesions towards PDACs.
