Intraductal papillary mucinous tumors of the pancreas confined to secondary ducts show less aggressive pathologic features as compared with those involving the main pancreatic duct
Intraductal papillary mucinous tumors of the pancreas confined to secondary ducts show less aggressive pathologic features as compared with those involving the main pancreatic duct
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DOI：
10.1097/00000478-200010000-00006
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发表时间：
2000-10-01
影响因子：
5.6
通讯作者：
Fléjou, JF
中科院分区：
文献类型：
--
作者：
Terris, B;Ponsot, P;Fléjou, JF
摘要胰脏导管内乳头状黏液性肿瘤是一种罕见的肿瘤，具有恶性潜能。由于影像学检查的进步，现在可以发现较小的胰腺囊性病变，其中一些对应于IPMT，涉及扩张的胰腺分支管，但保留主胰管。为探讨IPMT的分支型和主干型在形态和临床表现上的差异，我们对43例IPMT进行了外科系列研究。我们分析了1987年10月至1998年7月间在我们机构手术切除的所有IPMT的病理标本。在所有情况下，对整个胰腺标本进行系统检查。分支型IPMT 13例（30%），主胰管型IPMT 30例（70%），累及主胰管和分支管。分支型IPMT患者较年轻（中位年龄55岁vs 64岁），除1例病变外，所有病变均位于胰腺头颈部（相比30例主管型患者中的17例）。囊肿大小为4~55mm，大部分病例的主动脉导管轻度扩张。与主胰管型相比，主胰管型分别在30例患者中的11例（37%）和30例患者中的6例（20%）中显示浸润性癌和原位癌，分支型的IPMT显示显著较低的侵袭性组织学病变，其中5例（39%）为单纯性增生，6例（46%）为不典型增生，原位癌2例（15%）。在该组中没有观察到浸润性癌，分支型IPMT发生在年轻患者中，与主胰管型相比，与侵袭性较低的组织学特征相关。我们的发现提出了分支型IPMT作为一个特殊群体的临床管理难题。
Intraductal papillary mucinous tumors (IPMTs) of the pancreas are rare tumors characterized by a malignant potential. Because of the progress of imaging procedures, smaller cystic pancreatic lesions are now detected and some of them correspond to IPMTs that involve ectatic pancreatic branch ducts but spare the main pancreatic duct. To investigate differences in morphology and clinical behavior of branch and main duct types of IPMT, a surgical series of 43 cases was studied. All pathologic specimens of IPMT, surgically resected in our institution between October 1987 and July 1998, were analyzed. In all cases, the entire pancreatic specimen was systematically examined. IPMT of the branch type was found in 13 (30%) patients, whereas IPMT of main pancreatic duct type that involved the main pancreatic duct and branch ducts was observed in 30 (70%) patients. Patients with IPMT of the branch type were younger (median age, 55 yrs vs 64 yrs), and all but one of the lesions were located in the head and neck of the pancreas (vs 17 of 30 patients with the main duct type). The size of the cysts ranged from 4 to 55 mm, and the major duct showed a mild dilation in most cases. in contrast to the main pancreatic duct type, which showed invasive carcinoma and in situ carcinoma in 11 (37%) of 30 patients and 6 (20%) of 30 patients, respectively, IPMT of the branch type showed significantly less aggressive histologic lesions with five (39%) patients with simple hyperplasia, six (46%) patients with atypical hyperplasia, and two (15%) patients with in situ carcinoma. No invasive carcinoma was observed in this group, IPMT of the branch type occurs in younger patients and is associated with less aggressive histologic features than is the main pancreatic duct type. Our findings raise the difficult issue of clinical management of IPMT of the branch type as a distinctive group.