Mode of progression of intraductal papillary-mucinous tumor of the pancreas: analysis of patients with follow-up by EUS
Mode of progression of intraductal papillary-mucinous tumor of the pancreas: analysis of patients with follow-up by EUS
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DOI：
10.1007/s00535-005-1619-7
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发表时间：
2005-07-01
影响因子：
6.3
通讯作者：
Kobari, M
中科院分区：
文献类型：
--
作者：
Kobayashi, G;Fujita, N;Kobari, M
背景资料。目的探讨胰腺导管内乳头状黏液性肿瘤(IPMN)的进展模式，以阐明其恶性特点，并制定有效的治疗策略。51例IPMN患者(支管型47例，主管型4例)均行超声内窥镜(EUS)随访，平均随访时间41.0+/-32.3个月，平均随访4.4次。评价EUS表现的时间变化和切除标本的组织学改变。在分支管型患者中，仅2%的患者表现为扩张的分支增大。在主管型组中，75%的患者观察到主胰管(MPD)增大。在14例乳头状突起的患者中，分别有71%和43%的人观察到乳头状突起的大小和侧向扩散。没有患者患上浸润性癌症。在15例有厚隔样结构(TSS)的患者中，乳头状突和浸润性癌的发生率分别为53%和13%。29例具有薄的隔膜样结构的患者没有变化。2例致密多房大囊肿伴TSS患者发展为浸润性癌，囊性病变无变化。1例癌变为多灶性间质侵犯。没有乳头状突或TSS的分支管型IPMN患者不能立即接受手术。那些有细小乳头突起的人有一个良性的病程。建议对大支管型TSS患者进行手术治疗。对分支管型IPMN患者进行随访检查时应注意整个胰腺，因为浸润性导管腺癌可发生在胰腺内不同于IPMN的部位。
Background. We investigated the mode of progression of intraductal papillary-mucinous neoplasm of the pancreas (IPMN) in patients who underwent follow-up in order to elucidate the characteristics of malignancy and to establish an effective treatment strategy.Methods. Fifty-one patients with IPMN (branch-duct type, 47; main-duct type, 4) who had undergone follow-up study by endoscopic ultrasonography (EUS) were included (mean follow-up duration, 41.0 +/- 32.3 months; average number of EUS examinations performed during follow-up, 4.4). Chronological changes in EUS findings and histological findings of resected specimens were evaluated.Results. Of the patients with the branch-duct type, only 2% showed enlargement of the dilated branches. In the main-duct-type group, an increase in size of the main pancreatic duct (MPD) was observed in 75% of the patients. In 14 patients with papillary protrusions, an increase in size and lateral spread was observed in 71% and 43%, respectively. No patients developed invasive cancer. In 15 patients who had thick septum-like structures (TSS), the development of papillary protrusions and that of invasive cancer were observed in 53% and 13%, respectively. Twenty-nine patients who had thin septum-like structures showed no change. Two patients with dense multilocular large cysts and TSS developed invasive cancer without change in the cystic lesions. One patient developed carcinoma with multifocal stromal invasion.Conclusion. Patients with branch-duct type IPMNs without papillary protrusions or TSS are not immediate candidates for surgery. Those who have small papillary protrusions have a benign course. It is recommended that patients with the large branch-duct type with TSS should undergo surgery. Attention should be paid to the entire pancreas when performing follow-up examinations in patients with branch-duct type IPMN, as invasive ductal adenocarcinoma can develop at a site in the pancreas different from that of the IPMN.