Retrospective Analysis Of Intraductal Papillary Mucinous Neoplasms Of Pancreas In12Cases

Background:Intraductal papiliary mucinous neoplasms (IPMNs) is a kind of pancreas cystic tumors that is been increasingly recognized in recent years, accounting for about one third of all the surgical resection pancreatic cystic tumors. IPMNs patients usually do not show any specific clinical symptoms, mostly were found in imaging for other indications, while the treatment and prognosis of IPMNs vary according to different types, but preoperative assessment of the likelihood of malignancy or invasive in IPMNs of the pancreas is still difficult, so accurate preoperative diagnosis and correct managemet of IPMNs is a problem needs to be further investigated.Methods:Data of12IPMNs patients in Second Affiliated Hospital of Zhejiang University School of Medicine from January2000to December2012were collected and retrospective analysed. Comparing with results in other literature, we summarized experience in diagnosis and treatment of IPMNs, also predictive factors for malignancy and invasive carcinoma in IPMNs were analysed.Results:12patients with IPMNs of the pancreas were admitted between January,2000and December,2012in our hospital, and10were male and2were female while age onsets vary from53to81(mean age,66.8years).8complained of upper abdomen or lower back pain,5had weight loss and1patient had a history of pancreatitis. Laboratory tests did not show any specific results:2patients with elevated CEA and3patients with CA19-9elevated. Ultrasound, CT, MRI and EUS were performed in the patients.5patients were considered with IPMNs,4were diagnosed by CT or MRI while4by EUS.8patients underwent pancreatoduodenectomy,1underwent total pancreatectomy and the other one underwent distal pancreatectomy and splenectomy. Postoperative pathological diagnosis showed intraductal papillary mucinous adenoma in2patients,2cases of borderline lesions,1patient had carcinoma in situ and5with invasive lesions. Malignant IPMNs tumor’s longest diameter was44.7±26.4mm, while benign IPMNs maximum tumor diameter was20.8±7.5mm (p=0.039). Univariate analysis identified three predictive factors for malignancy:the tumor diameter of2.5cm or more (p=0.030); main-duct type and main pancreatic duct (p=0.030); diameter of7mm or more (p=0.008). Main pancreatic duct diameter more than7mm was also indicative of invasive carcinoma (p=0.044).Conclusion:IPMNs is a disease with a male predominance in Asian population. The preoperative diagnosis is diffucult, and mainly depends on imaging studies. Tumor diameter of2.5cm or more; main-duct type and main pancreatic duct diameter of7mm or more should be considered in the diagnosis of IPMNs to facilitate appropriate management.