Department of Gastroenterology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
Pancreas. 2010 Jul;39(5):653-7. doi: 10.1097/MPA.0b013e3181c81b52.
Main duct intraductal papillary mucinous neoplasms (IPMNs) of the pancreas include neoplasms with varying likelihood of progression to malignancy. The aim of this study was to investigate a natural course of main duct IPMNs with a lower likelihood of malignancy.
Twenty main duct IPMNs with a lower likelihood of malignancy, which was defined as mural nodule of less than 10 mm or no visualized mural nodule, and negative result of cytological examination of pancreatic juice, underwent regular ultrasound every 3 months. Special imaging examinations and additional pancreatic juice cytological examination were performed when necessary. Surgery was considered when a mural nodule enlarged to 10 mm or the cytological examination result indicated malignancy.
During a mean of 70 months, 12 IPMNs (60%) did not progress and 6 (30%) progressed within a lower likelihood of malignancy. The remaining 2 IPMNs (10%) progressed to meet the criteria for resection, underwent surgery, and were demonstrated to be carcinomas.
Main duct IPMN with a lower likelihood of malignancy was divided into 2 subgroups: neoplasm that progressed and that which did not progress during its natural course. The former should be resected considering its malignant potential, whereas the latter may be managed nonsurgically as long as it stays unchanged.
胰腺主胰管内乳头状黏液性肿瘤（IPMN）包括恶性潜能不同的肿瘤。本研究旨在探讨恶性潜能较低的主胰管 IPMN 的自然病程。
20 例恶性潜能较低的主胰管 IPMN，定义为壁结节小于 10mm 或无可见壁结节，且胰液细胞学检查阴性，每 3 个月行常规超声检查。必要时行特殊影像学检查和额外胰液细胞学检查。当壁结节增大至 10mm 或细胞学检查结果提示恶性时，考虑手术治疗。
在平均 70 个月的随访中，12 例（60%）IPMN 无进展，6 例（30%）在恶性潜能较低的情况下进展。其余 2 例（10%）进展至符合切除标准，行手术切除，证实为癌。
恶性潜能较低的主胰管 IPMN 可分为 2 个亚组：进展性和非进展性肿瘤。前者具有恶性潜能，应考虑手术切除，而后者只要保持不变，可以非手术方式治疗。
