Natural history of branch duct intraductal papillary mucinous neoplasm with mural nodules: a Japan Pancreas Society multicenter study.
Natural history of branch duct intraductal papillary mucinous neoplasm with mural nodules: a Japan Pancreas Society multicenter study.
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DOI：
10.1097/mpa.0000000000000080
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发表时间：
2014-05
期刊：
影响因子：
2.9
通讯作者：
Working Group for the Natural History of IPMN of the Japan Pancreas Society
中科院分区：
文献类型：
--
作者：
Kobayashi G;Fujita N;Maguchi H;Tanno S;Mizuno N;Hanada K;Hatori T;Sadakari Y;Yamaguchi T;Tobita K;Doi R;Yanagisawa A;Tanaka M;Working Group for the Natural History of IPMN of the Japan Pancreas Society
本研究旨在阐明胰腺导管内乳头状黏液性肿瘤伴分支导管壁结节（BD-IPMN）的自然病程。在日本10家机构进行长期随访的402例注册BD-IPMN患者中，53例经内镜超声检查发现MN高度小于10 mm的患者纳入本研究。观察其形态学改变及手术切除标本的组织学表现。初始诊断时MN的中位高度为3 mm（范围，1-8 mm），53例患者中有12例（23%）在随访期间（平均持续时间，42个月）MN高度增加。6例患者因MN高度增加而接受手术，1例患者发生高度异型增生，5例患者发生低度异型增生。没有患者发生IPMN来源的浸润性癌，1例（2%）患者发生明显的胰腺导管腺癌。BD-IPMN中恶性肿瘤（包括明显的胰腺导管腺癌）的发生率与无MN的发生率相似。对于MN高度小于10 mm的BD-IPMN患者，认为可以进行观察而不是立即切除。
This study aimed to elucidate the natural history of intraductal papillary mucinous neoplasm (IPMN) of the pancreas with mural nodules (MNs) in branch duct IPMN (BD-IPMN). Among the 402 registered patients with BD-IPMN on long-term follow-up at 10 institutions in Japan, 53 patients with MNs of less than 10 mm in height detected by endosonography were included in this study. The morphological changes of the BD-IPMN in these patients and histologic findings of the resected specimen were investigated. The median height of the MNs at the initial diagnosis was 3 mm (range, 1–8 mm), and 12 (23%) of the 53 patients showed an increase in the height of the MNs during follow-up (mean duration, 42 months). Six patients underwent surgery because of an increase in the height of MNs, yielding high-grade dysplasia in 1 patient and low-grade dysplasia in 5 patients. No patients developed invasive carcinoma derived from IPMN, and distinct pancreatic ductal adenocarcinoma developed in 1 (2%) patient. The incidence of the development of malignancy in BD-IPMNs, including distinct pancreatic ductal adenocarcinoma, was similar to that of those without MNs. In patients who have BD-IPMN with MNs of less than 10 mm in height, observation instead of immediate resection is considered to be possible.