Not all mixed-type intraductal papillary mucinous neoplasms behave like main-duct lesions: Implications of minimal involvement of the main pancreatic duct

Klaus Sahora, C. F.D. Castillo, Fei Dong, Giovanni Marchegiani, Sarah P. Thayer, Cristina R. Ferrone, Dushyant V. Sahani, William R. Brugge, Andrew L. Warshaw, Keith D. Lillemoe, Mari Mino-Kenudson

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Background The malignant potential of intraductal mucinous neoplasm of the pancreas (IPMN) is associated closely with main pancreatic duct (MPD) involvement. Because mixed-type IPMN is thought to have the same malignant potential as that of main-duct (MD)-IPMN, resection is recommended; however, the biological nature of mixed-type IPMN with only minimal involvement of MPD (min-mix-IPMN) may be different. Methods A prospective database of 404 resected IPMNs was re-reviewed to subclassify mixed-type IPMNs. We defined min-mix-IPMN as absence of gross abnormalities (except for dilatation) of MPD and noncircumferential microscopic involvement of MPD limited to few sections. Results We identified 46 min-mix-IPMNs, 163 IPMNs with extensive involvement of MPD (ex-mix-IPMN), 175 branch-duct (BD)-IPMNs, and 20 MD-IPMNs. The majority of min-mix-IPMNs were found incidentally and increased cyst size on surveillance was the leading operative indication. The median diameter of MPD was 2 mm in min-mix-IPMN versus 9 mm in ex-mix-IPMN (P <.0001), and cysts ≥10 mm were present in 62% of ex-mix-IPMNs versus 93% of min-mix-IPMNs (P <.0001). Most importantly, the vast majority of min-mix-IPMNs exhibited gastric-type epithelium, similar to BD-IPMNs, whereas intestinal-type epithelium was present in half of ex-mix-IPMNs, similar to MD-IPMNs. The prevalence of high-grade lesions was less in min-mix-IPMN than ex-mix-IPMN (P <.0001). These differences were reflected in better disease-specific outcomes of min-mix-IPMN compared with ex-mix-IPMN (P =.046). Conclusion Min-mix-IPMN often presents with no MPD dilation and is an incidental finding by microscopic examination. min-mix-IPMN shares the pathologic features and less aggressive biology with BD-IPMN. We propose that min-mix-IPMN be categorized differently than ex-mix-IPMN.

Original languageEnglish (US)
Pages (from-to)611-621
Number of pages11
JournalSurgery (United States)
Volume156
Issue number3
DOIs
StatePublished - Sep 2014

Fingerprint

Pancreatic Ducts
Neoplasms
Cysts
Dilatation
Incidental Findings
Intestinal Mucosa
Pancreatic Neoplasms
Stomach
Epithelium
Databases

ASJC Scopus subject areas

  • Surgery

Cite this

Not all mixed-type intraductal papillary mucinous neoplasms behave like main-duct lesions : Implications of minimal involvement of the main pancreatic duct. / Sahora, Klaus; Castillo, C. F.D.; Dong, Fei; Marchegiani, Giovanni; Thayer, Sarah P.; Ferrone, Cristina R.; Sahani, Dushyant V.; Brugge, William R.; Warshaw, Andrew L.; Lillemoe, Keith D.; Mino-Kenudson, Mari.

In: Surgery (United States), Vol. 156, No. 3, 09.2014, p. 611-621.

Research output: Contribution to journalArticle

Sahora, K, Castillo, CFD, Dong, F, Marchegiani, G, Thayer, SP, Ferrone, CR, Sahani, DV, Brugge, WR, Warshaw, AL, Lillemoe, KD & Mino-Kenudson, M 2014, 'Not all mixed-type intraductal papillary mucinous neoplasms behave like main-duct lesions: Implications of minimal involvement of the main pancreatic duct', Surgery (United States), vol. 156, no. 3, pp. 611-621. https://doi.org/10.1016/j.surg.2014.04.023
Sahora, Klaus ; Castillo, C. F.D. ; Dong, Fei ; Marchegiani, Giovanni ; Thayer, Sarah P. ; Ferrone, Cristina R. ; Sahani, Dushyant V. ; Brugge, William R. ; Warshaw, Andrew L. ; Lillemoe, Keith D. ; Mino-Kenudson, Mari. / Not all mixed-type intraductal papillary mucinous neoplasms behave like main-duct lesions : Implications of minimal involvement of the main pancreatic duct. In: Surgery (United States). 2014 ; Vol. 156, No. 3. pp. 611-621.
@article{fb3ebf5ac6094e8ba96cb2f67c43e1db,
title = "Not all mixed-type intraductal papillary mucinous neoplasms behave like main-duct lesions: Implications of minimal involvement of the main pancreatic duct",
abstract = "Background The malignant potential of intraductal mucinous neoplasm of the pancreas (IPMN) is associated closely with main pancreatic duct (MPD) involvement. Because mixed-type IPMN is thought to have the same malignant potential as that of main-duct (MD)-IPMN, resection is recommended; however, the biological nature of mixed-type IPMN with only minimal involvement of MPD (min-mix-IPMN) may be different. Methods A prospective database of 404 resected IPMNs was re-reviewed to subclassify mixed-type IPMNs. We defined min-mix-IPMN as absence of gross abnormalities (except for dilatation) of MPD and noncircumferential microscopic involvement of MPD limited to few sections. Results We identified 46 min-mix-IPMNs, 163 IPMNs with extensive involvement of MPD (ex-mix-IPMN), 175 branch-duct (BD)-IPMNs, and 20 MD-IPMNs. The majority of min-mix-IPMNs were found incidentally and increased cyst size on surveillance was the leading operative indication. The median diameter of MPD was 2 mm in min-mix-IPMN versus 9 mm in ex-mix-IPMN (P <.0001), and cysts ≥10 mm were present in 62{\%} of ex-mix-IPMNs versus 93{\%} of min-mix-IPMNs (P <.0001). Most importantly, the vast majority of min-mix-IPMNs exhibited gastric-type epithelium, similar to BD-IPMNs, whereas intestinal-type epithelium was present in half of ex-mix-IPMNs, similar to MD-IPMNs. The prevalence of high-grade lesions was less in min-mix-IPMN than ex-mix-IPMN (P <.0001). These differences were reflected in better disease-specific outcomes of min-mix-IPMN compared with ex-mix-IPMN (P =.046). Conclusion Min-mix-IPMN often presents with no MPD dilation and is an incidental finding by microscopic examination. min-mix-IPMN shares the pathologic features and less aggressive biology with BD-IPMN. We propose that min-mix-IPMN be categorized differently than ex-mix-IPMN.",
author = "Klaus Sahora and Castillo, {C. F.D.} and Fei Dong and Giovanni Marchegiani and Thayer, {Sarah P.} and Ferrone, {Cristina R.} and Sahani, {Dushyant V.} and Brugge, {William R.} and Warshaw, {Andrew L.} and Lillemoe, {Keith D.} and Mari Mino-Kenudson",
year = "2014",
month = "9",
doi = "10.1016/j.surg.2014.04.023",
language = "English (US)",
volume = "156",
pages = "611--621",
journal = "Surgery (United States)",
issn = "0039-6060",
publisher = "Mosby Inc.",
number = "3",

}

TY - JOUR

T1 - Not all mixed-type intraductal papillary mucinous neoplasms behave like main-duct lesions

T2 - Implications of minimal involvement of the main pancreatic duct

AU - Sahora, Klaus

AU - Castillo, C. F.D.

AU - Dong, Fei

AU - Marchegiani, Giovanni

AU - Thayer, Sarah P.

AU - Ferrone, Cristina R.

AU - Sahani, Dushyant V.

AU - Brugge, William R.

AU - Warshaw, Andrew L.

AU - Lillemoe, Keith D.

AU - Mino-Kenudson, Mari

PY - 2014/9

Y1 - 2014/9

N2 - Background The malignant potential of intraductal mucinous neoplasm of the pancreas (IPMN) is associated closely with main pancreatic duct (MPD) involvement. Because mixed-type IPMN is thought to have the same malignant potential as that of main-duct (MD)-IPMN, resection is recommended; however, the biological nature of mixed-type IPMN with only minimal involvement of MPD (min-mix-IPMN) may be different. Methods A prospective database of 404 resected IPMNs was re-reviewed to subclassify mixed-type IPMNs. We defined min-mix-IPMN as absence of gross abnormalities (except for dilatation) of MPD and noncircumferential microscopic involvement of MPD limited to few sections. Results We identified 46 min-mix-IPMNs, 163 IPMNs with extensive involvement of MPD (ex-mix-IPMN), 175 branch-duct (BD)-IPMNs, and 20 MD-IPMNs. The majority of min-mix-IPMNs were found incidentally and increased cyst size on surveillance was the leading operative indication. The median diameter of MPD was 2 mm in min-mix-IPMN versus 9 mm in ex-mix-IPMN (P <.0001), and cysts ≥10 mm were present in 62% of ex-mix-IPMNs versus 93% of min-mix-IPMNs (P <.0001). Most importantly, the vast majority of min-mix-IPMNs exhibited gastric-type epithelium, similar to BD-IPMNs, whereas intestinal-type epithelium was present in half of ex-mix-IPMNs, similar to MD-IPMNs. The prevalence of high-grade lesions was less in min-mix-IPMN than ex-mix-IPMN (P <.0001). These differences were reflected in better disease-specific outcomes of min-mix-IPMN compared with ex-mix-IPMN (P =.046). Conclusion Min-mix-IPMN often presents with no MPD dilation and is an incidental finding by microscopic examination. min-mix-IPMN shares the pathologic features and less aggressive biology with BD-IPMN. We propose that min-mix-IPMN be categorized differently than ex-mix-IPMN.

AB - Background The malignant potential of intraductal mucinous neoplasm of the pancreas (IPMN) is associated closely with main pancreatic duct (MPD) involvement. Because mixed-type IPMN is thought to have the same malignant potential as that of main-duct (MD)-IPMN, resection is recommended; however, the biological nature of mixed-type IPMN with only minimal involvement of MPD (min-mix-IPMN) may be different. Methods A prospective database of 404 resected IPMNs was re-reviewed to subclassify mixed-type IPMNs. We defined min-mix-IPMN as absence of gross abnormalities (except for dilatation) of MPD and noncircumferential microscopic involvement of MPD limited to few sections. Results We identified 46 min-mix-IPMNs, 163 IPMNs with extensive involvement of MPD (ex-mix-IPMN), 175 branch-duct (BD)-IPMNs, and 20 MD-IPMNs. The majority of min-mix-IPMNs were found incidentally and increased cyst size on surveillance was the leading operative indication. The median diameter of MPD was 2 mm in min-mix-IPMN versus 9 mm in ex-mix-IPMN (P <.0001), and cysts ≥10 mm were present in 62% of ex-mix-IPMNs versus 93% of min-mix-IPMNs (P <.0001). Most importantly, the vast majority of min-mix-IPMNs exhibited gastric-type epithelium, similar to BD-IPMNs, whereas intestinal-type epithelium was present in half of ex-mix-IPMNs, similar to MD-IPMNs. The prevalence of high-grade lesions was less in min-mix-IPMN than ex-mix-IPMN (P <.0001). These differences were reflected in better disease-specific outcomes of min-mix-IPMN compared with ex-mix-IPMN (P =.046). Conclusion Min-mix-IPMN often presents with no MPD dilation and is an incidental finding by microscopic examination. min-mix-IPMN shares the pathologic features and less aggressive biology with BD-IPMN. We propose that min-mix-IPMN be categorized differently than ex-mix-IPMN.

UR - http://www.scopus.com/inward/record.url?scp=84907597229&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84907597229&partnerID=8YFLogxK

U2 - 10.1016/j.surg.2014.04.023

DO - 10.1016/j.surg.2014.04.023

M3 - Article

C2 - 25081232

AN - SCOPUS:84907597229

VL - 156

SP - 611

EP - 621

JO - Surgery (United States)

JF - Surgery (United States)

SN - 0039-6060

IS - 3

ER -