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Pancreatology : Official Journal of the... 2012The international consensus guidelines for management of intraductal papillary mucinous neoplasm and mucinous cystic neoplasm of the pancreas established in 2006 have...
The international consensus guidelines for management of intraductal papillary mucinous neoplasm and mucinous cystic neoplasm of the pancreas established in 2006 have increased awareness and improved the management of these entities. During the subsequent 5 years, a considerable amount of information has been added to the literature. Based on a consensus symposium held during the 14th meeting of the International Association of Pancreatology in Fukuoka, Japan, in 2010, the working group has generated new guidelines. Since the levels of evidence for all items addressed in these guidelines are low, being 4 or 5, we still have to designate them "consensus", rather than "evidence-based", guidelines. To simplify the entire guidelines, we have adopted a statement format that differs from the 2006 guidelines, although the headings are similar to the previous guidelines, i.e., classification, investigation, indications for and methods of resection and other treatments, histological aspects, and methods of follow-up. The present guidelines include recent information and recommendations based on our current understanding, and highlight issues that remain controversial and areas where further research is required.
Topics: Carcinoma, Pancreatic Ductal; Humans; Neoplasms, Cystic, Mucinous, and Serous; Pancreas; Pancreatic Neoplasms; Papilloma, Intraductal
PubMed: 22687371
DOI: 10.1016/j.pan.2012.04.004 -
Khirurgiia 2019Intraductal papillary mucinous neoplasm (IPMN) is the most common cystic pancreatic tumor. There are 3 ductal types of this tumor depending on localization. Several... (Review)
Review
Intraductal papillary mucinous neoplasm (IPMN) is the most common cystic pancreatic tumor. There are 3 ductal types of this tumor depending on localization. Several histological subtypes determine clinical course and prognosis. The problems of diagnosis, surgical treatment and follow-up are reviewed in several guidelines. Literature review devoted to pancreatic IPMN is presented in the article, the latest guidelines are compared.
Topics: Humans; Pancreatic Intraductal Neoplasms; Pancreatic Neoplasms; Practice Guidelines as Topic; Prognosis
PubMed: 31714535
DOI: 10.17116/hirurgia201911181 -
Archives of Pathology & Laboratory... Jul 2017Solid pseudopapillary neoplasm of the pancreas is a rare entity with low malignant potential and excellent overall prognosis. It has nonspecific clinical presentations... (Review)
Review
Solid pseudopapillary neoplasm of the pancreas is a rare entity with low malignant potential and excellent overall prognosis. It has nonspecific clinical presentations such as abdominal pain and nausea, with vague radiologic features. Histologic features of this neoplasm are usually specific. The tumor shows minimally cohesive, uniform, monotonous cells lining delicate capillary-sized blood vessels, described as pseudopapillary architecture. Other features including hyaline globules, cytoplasmic vacuoles, and nuclear grooving are frequently present. Use of a select panel of immunostains always helps pathologists to differentiate this tumor from other circumscribed tumors of the pancreas. Recently, β-catenin, CD10, and E-cadherin have been shown to be very important in the diagnosis of solid pseudopapillary neoplasm. Nuclear staining of tumor cells by β-catenin and membranous presentation of CD10 is seen in almost 100% of cases. Tumor cells can be partially positive for synaptophysin and chromogranin. This tumor has a low malignant potential, and definite treatment is surgical resection.
Topics: Humans; Neoplasms, Glandular and Epithelial; Pancreatic Neoplasms
PubMed: 28661210
DOI: 10.5858/arpa.2016-0322-RS -
Journal of Gastrointestinal Surgery :... Jan 2021
Topics: Humans; Pancreas; Pancreatic Neoplasms
PubMed: 32410181
DOI: 10.1007/s11605-020-04644-0 -
Cirugia Y Cirujanos 2021Solid pseudopapillary tumor of the pancreas is a rare entity, more frequent in women between the 2 and 4 decades. The diagnosis is usually incidental and it can be...
Solid pseudopapillary tumor of the pancreas is a rare entity, more frequent in women between the 2 and 4 decades. The diagnosis is usually incidental and it can be reached by computed tomography or magnetic resonance imaging. Subsequent pathological confirmation is necessary for an adequate treatment. A retrospective study of six cases was carried out. All the patients were female, between 14 and 56 years of age, in which 50% the tumor were an incidental finding. We had three cases located in the head and three in the body of the pancreas. We performed three pancreaticoduodenectomies and three distal pancreatectomies with splenic preservation, without disease recurrence.
Topics: Female; Humans; Neoplasm Recurrence, Local; Pancreas; Pancreatectomy; Pancreatic Neoplasms; Retrospective Studies
PubMed: 33784288
DOI: 10.24875/CIRU.19001163 -
Folia Medica Dec 2021Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a relatively new entity that has gained increased attention because of its unique features - presence... (Review)
Review
Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a relatively new entity that has gained increased attention because of its unique features - presence of different subtypes with different malignant potential, biological behavior, and prognosis, higher rates of recurrences and concomitant or metachronous pancreatic duct cancer. It is rare with an incidence of 4 to 5 cases per 100 000. The relative lack of experience significantly hampers decision making for surgery (pancreatic head resection, distal pancreatectomy or enucleation) or follow-up.Herein we present two cases managed by diametrically different tactic according to the risk stratification - distal pancreatectomy with splenectomy and observation, respectively. An up-to-date literature review on the key points in diagnostics, indications for surgery, the extent of surgery, follow-up, and prognosis is provided.The tailored approach based on risk stratification is the cornerstone of management. Absolute indications for surgery are the lesions with high-risk stigmata, whereas the worrisome features should be evaluated by endoscopic ultrasound and fine-needle aspiration. Main duct and mixed type are usually referred to surgery, whereas the management of a branch type is more conservative due to the lower rate of invasive cancer. Strict postoperative follow-up is mandatory even in negative resection margins due to a high risk for recurrences and metachronous lesions.Despite the guidelines, the intraductal papillary mucinous neoplasm remains a major challenge for clinicians and surgeons in the balance the risk/benefit of observation versus resection. Risk stratification plays a key role in decision-making. Future trials need to determine the optimal period of surveillance and the most reliable predictive factors for concomitant pancreatic duct cancer.
Topics: Adenocarcinoma, Mucinous; Carcinoma, Pancreatic Ductal; Humans; Pancreas; Pancreatectomy; Pancreatic Neoplasms; Recurrence; Retrospective Studies
PubMed: 35851243
DOI: 10.3897/folmed.63.e63071 -
Gut May 2018Evidence-based guidelines on the management of pancreatic cystic neoplasms (PCN) are lacking. This guideline is a joint initiative of the European Study Group on Cystic...
Evidence-based guidelines on the management of pancreatic cystic neoplasms (PCN) are lacking. This guideline is a joint initiative of the European Study Group on Cystic Tumours of the Pancreas, United European Gastroenterology, European Pancreatic Club, European-African Hepato-Pancreato-Biliary Association, European Digestive Surgery, and the European Society of Gastrointestinal Endoscopy. It replaces the 2013 European consensus statement guidelines on PCN. European and non-European experts performed systematic reviews and used GRADE methodology to answer relevant clinical questions on nine topics (biomarkers, radiology, endoscopy, intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm (MCN), serous cystic neoplasm, rare cysts, (neo)adjuvant treatment, and pathology). Recommendations include conservative management, relative and absolute indications for surgery. A conservative approach is recommended for asymptomatic MCN and IPMN measuring <40 mm without an enhancing nodule. Relative indications for surgery in IPMN include a main pancreatic duct (MPD) diameter between 5 and 9.9 mm or a cyst diameter ≥40 mm. Absolute indications for surgery in IPMN, due to the high-risk of malignant transformation, include jaundice, an enhancing mural nodule >5 mm, and MPD diameter >10 mm. Lifelong follow-up of IPMN is recommended in patients who are fit for surgery. The European evidence-based guidelines on PCN aim to improve the diagnosis and management of PCN.
Topics: Europe; Evidence-Based Practice; Humans; Pancreas; Pancreatic Cyst; Pancreatic Neoplasms; Practice Guidelines as Topic
PubMed: 29574408
DOI: 10.1136/gutjnl-2018-316027 -
The Surgical Clinics of North America Dec 2016The incidence of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas has been rising in the past 2 decades, driven mainly by the widespread use of... (Review)
Review
The incidence of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas has been rising in the past 2 decades, driven mainly by the widespread use of cross-sectional imaging. IPMNs are intraductal mucin-producing neoplasms that involve the main pancreatic duct or its side branches and lack the ovarian stroma typically seen in mucinous cystic neoplasms. The International Association of Pancreatology released consensus guidelines in 2006 and 2012 providing clinical algorithms based on IPMN features and risk of malignancy. In this article, we review the different classifications of IPMNs, their natural history, and clinical management and address recent controversies in the literature.
Topics: Carcinoma, Pancreatic Ductal; Carcinoma, Papillary; Combined Modality Therapy; Humans; Neoplasm Staging; Pancreatic Neoplasms
PubMed: 27865286
DOI: 10.1016/j.suc.2016.07.009 -
Pancreas Feb 2023The aim of the study is to summary the clinicopathological characteristics and surgical outcomes of solid pseudopapillary neoplasm (SPN) of the pancreas.
OBJECTIVES
The aim of the study is to summary the clinicopathological characteristics and surgical outcomes of solid pseudopapillary neoplasm (SPN) of the pancreas.
METHODS
In this retrospective study, the information of 118 patients with SPN from 3 hospitals were analyzed.
RESULTS
A total of 118 patients. The mean age was 30.8 (standard deviation, 14.7) years and the majority were female (n = 95, 80.5%). Sixty-seven patients (56.8%) had clinical symptoms, of which the most common symptom was abdominal pain (49.6%). The mean tumor size was 5.9 (standard deviation, 2.9) cm. Pseudopapillary architecture was the commonest histologic feature, and β-catenin, CD56, vimentin, neuron-specific enolase, CD10, a1-antitrypsin, cytokeratins showed different degrees of positive expression in immunohistochemical staining. Fourteen patients (11.9%) presented aggressive pathologic behavior, which was correlated to the incomplete tumor capsule. At a median follow-up of 59.2 months, the recurrence rate was 1.8% and the overall 5-year survival rate was 97.7%.
CONCLUSIONS
Solid pseudopapillary neoplasm of the pancreas is a potentially low-grade malignant tumor that most frequently found in young females. Its clinical manifestations are nonspecific and the diagnosis mostly depends on pathological examination. Surgical resection is the first choice of treatment for SPN with a good prognosis.
Topics: Adult; Female; Humans; Male; Abdominal Pain; Pancreas; Pancreatic Neoplasms; Retrospective Studies
PubMed: 37523603
DOI: 10.1097/MPA.0000000000002219 -
Journal of Gastrointestinal Surgery :... Jan 2021
Topics: Carcinoma, Pancreatic Ductal; Humans; Pancreas; Pancreatic Neoplasms
PubMed: 32394127
DOI: 10.1007/s11605-020-04638-y