Allen Peter J
Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
Surg Oncol Clin N Am. 2010 Apr;19(2):297-310. doi: 10.1016/j.soc.2009.11.002.
Intraductal papillary mucinous neoplasms (IPMN) are mucinous cystic tumors of the pancreas, which were first classified into a unified diagnosis by the World Health Organization in 1996. These lesions originate from the cells of the pancreatic ductal system and may grossly or microscopically involve the pancreatic ducts in a diffuse or multifocal fashion. As experience with IPMN increases, it is becoming more evident that this process presents as a spectrum of neoplasia with significant variation regarding the clinical and radiologic presentation, malignant potential, and disease-specific outcome. IPMN encompasses a spectrum of precursor lesions, from adenoma to intraductal carcinoma to invasive cancer, with molecular data supporting the premise that this dysplastic process has the potential to progress from low-grade dysplasia to invasive carcinoma. Controversy over the management of IPMN exists because of the difficulty in obtaining a preoperative histologic diagnosis, the broad spectrum of neoplasia, the lack of understanding as to the frequency and time to malignant progression. This article describes the radiologic and histopathologic classification system of IPMN; the biologic behavior of these lesions, and the diagnostic testing most commonly used, and discusses the current treatment controversies.
导管内乳头状黏液性肿瘤（IPMN）是胰腺的黏液性囊性肿瘤，1996年世界卫生组织首次将其归类为统一诊断。这些病变起源于胰腺导管系统的细胞，在大体或显微镜下可能以弥漫或多灶性方式累及胰腺导管。随着对IPMN经验的增加，越来越明显的是，这个过程表现为一系列肿瘤形成，在临床和放射学表现、恶性潜能以及疾病特异性结局方面存在显著差异。IPMN包括一系列前驱病变，从腺瘤到导管内癌再到浸润性癌，分子数据支持这种发育异常过程有可能从低级别发育异常进展为浸润性癌的前提。由于术前难以获得组织学诊断、肿瘤形成范围广泛、对恶性进展的频率和时间缺乏了解，IPMN的管理存在争议。本文描述了IPMN的放射学和组织病理学分类系统；这些病变的生物学行为，以及最常用的诊断检测方法，并讨论了当前的治疗争议。
