Intraductal papillary-mucinous tumors of the pancreas: Clinicopathologic features, outcome, and nomenclature
Intraductal papillary-mucinous tumors of the pancreas: Clinicopathologic features, outcome, and nomenclature
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DOI：
10.1053/gast.1996.v110.pm8964418
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发表时间：
1996-06-01
期刊：
影响因子：
29.4
通讯作者：
Dimagno, EP
中科院分区：
文献类型：
--
作者：
Loftus, EV;OlivaresPakzad, BA;Dimagno, EP
背景与目的：胰腺导管内乳头状黏液性肿瘤(IPMT)日益受到人们的重视，本研究旨在探讨临床、影像或组织学特征是否预示预后，制定治疗方案，明确IPMT与胰腺粘液性囊性肿瘤(MCN)和慢性胰腺炎之间的关系。方法：回顾分析1983年10月至1994年1月收治的15例IPMT患者的病历、X线片及病理标本。结果：肝转移瘤1例，手术治疗14例(胰腺远端切除6例，全胰腺切除4例，胰腺十二指肠切除4例)，均为导管内上皮发育不良和慢性胰腺炎，3例为浸润性腺癌。中位生存期25个月后，10例存活；4例恶性肿瘤中3例死亡，11例良性IPMT中2例死亡(P<；0.05)，有癌或无癌的患者具有相似的临床和放射学特征，9例良性IMPT患者被诊断为慢性胰腺炎，无一例恶性IPMT(P<；0.05)。结论：IPMT是一种异常增生性和可能的癌前病变，常被诊断为慢性胰腺炎，与MCN分开，因为术前无法区分非侵袭性和侵袭性IPMT，只要合适，完全切除异常增生性胰腺炎是我们选择的治疗方法。
Background & Aims: Intraductal papillary-mucinous tumor (IPMT) of the pancreatic ducts is increasingly recognized, This study investigated if clinical, imaging, or histological features predicted outcome, formulated a treatment algorithm, and clarified relationships among IPMT, mucinous cystic neoplasms of the pancreas (MCN), and chronic pancreatitis, Methods: The medical records, radiographs, and pathological specimens of 15 patients with IPMT (dilated main pancreatic duct or branch ducts with mucin overproduction) who were evaluated between October 1983 and January 1994 were reviewed. Results: One patient had hepatic metastases, Fourteen underwent an operation (6 distal pancreatectomy, 4 total pancreatectomy, and 4 pancreaticoduodenectomy); all had dysplastic intraductal epithelium and chronic pancreatitis, whereas 3 had invasive adenocarcinoma. After a median of 25 months, 10 patients were alive; 3 of 4 with malignant and 2 of 11 with benign IPMT died (P < 0.05), Patients with or without carcinoma had similar clinical and radiographic features, A clinical diagnosis of chronic pancreatitis had been made in 9 patients with benign IMPT and in none with malignant IPMT(P < 0.05), Conclusions: IPMT is a dysplastic and likely precancerous lesion that is frequently diagnosed as chronic pancreatitis and is separate from MCN, Because it is not possible to distinguish noninvasive from invasive IPMT preoperatively, complete surgical excision of the dysplastic process is our treatment of choice whenever appropriate.