Intraductal papillary-mucinous neoplasms of the pancreas - An analysis of in situ and invasive carcinomas in 28 patients
Intraductal papillary-mucinous neoplasms of the pancreas - An analysis of in situ and invasive carcinomas in 28 patients
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DOI：
10.1002/cncr.10203
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发表时间：
2002-01-01
期刊：
影响因子：
6.2
通讯作者：
Klimstra, DS
中科院分区：
文献类型：
--
作者：
Adsay, NV;Conlon, KC;Klimstra, DS
背景胰腺导管内乳头状粘液性肿瘤是一种具有不同量乳头形成、粘液产生和细胞结构异常的导管内肿瘤。据报道，30%的患者发生在LIP中的相关浸润性癌通常是粘液性的，临床上是惰性的。本文对1983 ~ 1997年在纪念斯隆-凯特琳癌症中心切除的28例IPMN的临床和病理特点进行了回顾性分析。年龄44-79岁，平均68岁。肿瘤大小1.5 ~ 11.0cm，平均4.5cm。腹痛、体重减轻和无胆便是最常见的症状。根据组织学，确定了两种类型的乳头：肠（22例）和胰胆（6例）。在导管内成分中，软脑膜的细胞学检查最少（即，2例为导管内乳头状黏液性腺瘤（IPM腺瘤），5例为中度IPM交界性腺瘤，21例为重度IPM原位癌。此外，15例患者（53%）中发现浸润性癌，其中4例仅有显微镜下病灶。浸润性癌为粘液型（胶样）6例，管状型（传统导管腺癌）9例。在中位随访35个月时，4名患者死于疾病;其中2名患者仅为边缘性乳腺癌，在提交的切片中未发现原位癌或浸润性癌。18例患者无任何证据或疾病，1例患者因疾病复发而存活，5例患者死于其他原因。精算5年无病生存率为78%。浸润性癌14例，胶质型肿瘤6例，5例平均随访55个月。在死亡的管状浸润性癌患者中，2例患者死于疾病（分别在4年和7年），3例患者死于其他原因，4例患者存活（3例无疾病，1例复发），平均随访时间为7.5年。IPMN患者的导管内乳头有两种不同的类型：肠乳头和胰胆管乳头。原位癌和浸润性癌都可能比以前认识到的更常见。管状型浸润性癌与粘液型（胶样）癌一样发生。尽管肿瘤作为一个组比传统的胰腺导管腺癌侵袭性低，但具有IPMN的患者可能追求致命的过程，即使在没有可识别的浸润性癌的情况下。相反，在IPMN背景下出现的管状浸润性癌患者可能比无IPMN的常规导管腺癌患者遵循更有利的过程，强调了认识胰腺癌患者中IPMN成分的重要性。(C)2002年美国癌症协会。
BACKGROUND. Intraductal papillary-mucinous neoplasms (IPMNs) of the pancreas are intraductal tumors with variable amounts of papilla formation, mucin production, and cytoarchitectural atypia. Associated invasive carcinomas, reported to occur in LIP to 30% of patients, often are mucinous and clinically indolent.METHODS. The clinical and pathologic features of 28 IPMNs resected at Memorial Sloan-Kettering Cancer Center between 1983 and 1997 were reviewed.RESULTS. There were 16 females and 12 males v with a mean age of 68 years (range, 44-79 years) and a mean tumor size of 4.5 cm (range, 1.5- 11.0 cm), The head of the gland was the predominant tumor site (89%). Abdominal pain, weight loss, and acholic stool were the most common symptoms at presentation. According to histology, two types of papillae were identified: intestinal (22 patients) and pancreatobiliary (6 patients). In the intraductal component, cytologic at pia was minimal (i.e., intraductall papilla ry-mucinous [IPM] adenoma) in 2 patients and moderate (IPM borderline tumor) in 5 patients, and severe atypia (IPM carcinoma in situ) was seen at least focally in 21 patients. In addition, invasive carcinoma was identified in 15 patients (53%), 4 of whom had only microscopic foci. Invasive carcinoma was of die mucinous type (colloid) in six patients and of the tubular type (conventional ductal adenocarcinoma) in nine patients. At a median follow-up of 35 months, four patients died of disease; two of these patients had only borderline atypia with no identified in situ or invasive carcinoma in the sections submitted. Eighteen patients had no evidence or disease, 1 patient was alive with recurrent disease, and 5 patients died of other causes. The actuarial 5-year disease free survival rate was 78%. Of the 14 patients v with invasive carcinoma, 5 of 6 patients with colloid type tumors were free or tumor at a mean of 55 months. Of die patient, with tubular type invasive carcinoma, two patients died of their disease (at 4 years and 7 years), three patients died of other causes, and four patients were alive (three were free of disease, and one experienced disease recurrence) at an average follow-up of 7.5 years.CONCLUSIONS. Two distinct patterns of intraductal papillae are seen in patients with IPMNs: intestinal and pancreatobiliary. Both in Situ and invasive carcinoma may be encountered more commonly dian previously recognized. Tubular type invasive carcinomas occur as well as mucinous type (colloid) carcinomas, Although the neoplasms are less aggressive as a group than conventional pancreatic ductal adenocarcinoma, patients with [IPMNs may pursue a deadly course, even in the absence of identifiable invasive carcinoma. Conversely, patients with tubular type invasive carcinoma a-rising in the background of IPMN may follow a more favorable course than patients with conventional ductal adenocarcinoma without IPMN, emphasizing the importance of recognizing the IPMN component in patients with Pancreatic adenocarcinoma. (C) 2002 American Cancer Society.