Pancreatic tumors with cystic dilatation of the ducts: intraductal papillary mucinous neoplasms and intraductal oncocytic papillary neoplasms.
Pancreatic tumors with cystic dilatation of the ducts: intraductal papillary mucinous neoplasms and intraductal oncocytic papillary neoplasms.
复制标题
伴有导管囊性扩张的胰腺肿瘤：导管内乳头状粘液性肿瘤和导管内嗜酸细胞性乳头状肿瘤。
DOI：
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发表时间：
2000
影响因子：
2.3
通讯作者：
D. Klimstra
中科院分区：
文献类型：
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作者：
Adsay Nv;D. Longnecker;D. Klimstra
导管内乳头状粘液性肿瘤（IPMN）和导管内嗜酸细胞乳头状肿瘤（IOPN）是胰腺导管内肿瘤的两种类型，由于导管扩张而可能出现囊性。两者的特征都是导管内粘液细胞增殖，通常排列成乳头状。这种增殖通常与管腔内粘蛋白积聚有关，从而产生导管囊性扩张，类似于粘液性囊性肿瘤。内窥镜和放射学研究以及仔细的宏观检查对于通过显示天然导管内的起源来正确诊断 IPMN 和 IOPN 至关重要。在显微镜下，这些肿瘤显示出一系列细胞结构异型性，范围从腺瘤到交界性癌和原位癌。尽管 IPMN 和 IOPN 被定义为“导管内肿瘤”，但约三分之一的病例与浸润性癌相关。因此，与普通导管腺癌相关的涉及较小导管的粘液性囊性肿瘤或胰腺上皮内瘤变一样，这些肿瘤似乎是浸润性癌的前兆。与 IPMN 相关的侵袭性癌是管状或胶体（粘液性非囊性）类型，而与 IOPN 相关的侵袭性癌可能是嗜酸细胞癌。即使存在浸润性癌，这些肿瘤也可能比普通导管腺癌经历更持久的临床病程。另一方面，尽管缺乏任何可识别的浸润性癌，但在侵袭性临床过程后发生 IPMN 的罕见例子已被记录在案。因此，应仔细检查IPMN和IOPN并广泛取样，首先确认主要病理是导管内过程，更重要的是排除浸润性癌的存在。
Intraductal papillary mucinous neoplasms (IPMNs) and intraductal oncocytic papillary neoplasms (IOPNs) are the 2 types of intraductal neoplasms of the pancreas that may appear cystic because of dilatation of the ducts. Both are characterized by intraductal proliferation of mucinous cells usually arranged in papillary patterns. This proliferation is often associated with intraluminal mucin accumulation, which produces cystic dilatation of the ducts, mimicking mucinous cystic neoplasms. Endoscopic and radiologic studies and careful macroscopic examination are crucial for the correct diagnosis of IPMNs and IOPNs by showing the origin within the native ducts. Microscopically, these tumors display a spectrum of cytoarchitectural atypia that ranges from adenoma to borderline and to carcinoma-in-situ. Although they are defined as "intraductal tumors," IPMNs and IOPNs are associated with invasive carcinoma in about a third of the cases. It, therefore, appears that, like mucinous cystic neoplasms or pancreatic intraepithelial neoplasia involving the smaller ducts associated with ordinary ductal adenocarcinomas, these tumors are precursors of invasive carcinoma. Invasive carcinomas associated with IPMNs are of either tubular or colloid (mucinous noncystic) types, whereas those associated with IOPNs may be oncocytic. Even in the presence of invasive carcinoma, these tumors may follow a more protracted clinical course than ordinary ductal adenocarcinoma. On the other hand, rare examples of IPMNs after an aggressive clinical course despite the lack of any identifiable invasive carcinoma are on record. Therefore, IPMNs and IOPNs should be examined carefully and sampled extensively, first, to confirm that the main pathology is an intraductal process and, more importantly, to rule out the presence of an invasive carcinoma.