Intraductal papillary mucinous neoplasms of the pancreas: an increasingly recognized clinicopathologic entity
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OBJECTIVE: To assess the authors' experience with intraductal papillary mucinous neoplasms of the pancreas (IPMNs). SUMMARY BACKGROUND DATA: Intraductal papillary mucinous neoplasms of the pancreas are being recognized with increasing frequency. METHODS: All patients who underwent pancreatic resection for an IPMN at the Johns Hopkins Hospital between January 1987 and December 2000 were studied. The data were compared with those of 702 concurrent patients with infiltrating ductal adenocarcinoma of the pancreas not associated with an IPMN resected by pancreaticoduodenectomy. RESULTS: In the 13-year time period, 60 patients underwent pancreatic resection for IPMNs, with 40 patients undergoing resection in the past 3 years. Mean age at presentation was 67.4 +/- 1.4 years. The most common presenting symptom in patients with IPMNs was abdominal pain (59%). Most IPMNs were in the head of the pancreas or diffusely involved the gland, with 70% being resected via pancreaticoduodenectomy, 22% via total pancreatectomy, and 8% via distal pancreatectomy. Twenty-two patients (37%) had IPMNs with an associated infiltrating adenocarcinoma. In a subset of IPMNs immunohistochemically stained for the Dpc4 protein (n = 50), all of the intraductal or noninvasive components strongly expressed Dpc4, whereas 84% of associated infiltrating cancers expressed Dpc4. The 5-year survival rate for all patients with IPMNs (n = 60) was 57%. CONCLUSION: Intraductal papillary mucinous neoplasms represent a distinct clinicopathologic entity being recognized with increasing frequency. IPMNs are clinically, histologically, and genetically disparate from pancreatic ductal adenocarcinomas. The distinct clinical features, the presumably long in situ or noninvasive phase, and the good long-term survival of patients with IPMNs offer a unique opportunity for early diagnosis, curative resection, and further studies of the molecular genetics and natural history of these unusual neoplasms.
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TP53 and SMAD4 alterations typically occur late in multistep progression, usually in high-grade lesions or cancer in both PanINs and IPMNs.
“The temporal appearance of these alterations during multistep progression suggests that TP53 and SMAD4 typically occur late, usually in the setting of high-grade lesions or cancer in both PanINs and IPMNs23,51.”
From Pancreatic cancer: Advances and challenges (2023) · cites this paper as [51]
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- Authors
- Sohn, T. A., Yeo, C. J., Cameron, J. L., Iacobuzio-Donahue, C. A., Hruban, R. H., & Lillemoe, K. D.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Yeo, Charles J.
- Cameron, John L.
- Lillemoe, Keith D.
- Venue
- Annals of Surgery
- Published
- 2001-09
- Volume
- 234
- Issue
- 3
- Pages
- 313-322
- ISSN
- 0003-4932 (ISSN-L)
- PMC
- PMC1422022
- OpenAlex
- W2012794165
- Cited by
- 311
- References
- 28
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 3 · 2023: 5 · 2022: 5 · 2021: 3 · 2020: 3 · 2019: 2 · 2018: 7 · 2017: 3 · 2016: 7 · 2015: 8 · 2014: 10 · 2013: 12 · 2012: 11
- FWCI
- 8.13
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Annals of Surgery (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Cancer Institute (P50CA-62924, P50CA062924)
- Topics
- Health Sciences › Medicine › Oncology › Pancreatic and Hepatic Oncology Research
- Health Sciences › Medicine › Epidemiology › Neuroendocrine Tumor Research Advances
- Health Sciences › Medicine › Surgery › Pancreatitis Pathology and Treatment
- Keywords
- intraductal papillary mucinous neoplasm, pancreatic neoplasms, pancreaticoduodenectomy, total pancreatectomy, distal pancreatectomy, early diagnosis, clinicopathological features
- MeSH terms
- Adult, Aged, Aged, 80 and over, Adenocarcinoma, Mucinous, Carcinoma, Papillary, Female, Humans, Immunohistochemistry, Male, Middle Aged, Pancreatectomy, Pancreatic Neoplasms, Retrospective Studies, Survival Rate, Pancreaticoduodenectomy
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