Jaime Benarroch-Gampel, Taylor S Riall, Department of Surgery, The University of Texas Medical Branch, Galveston, TX 77555-0541, United States.
World J Gastrointest Surg. 2010 Oct 27;2(10):363-7. doi: 10.4240/wjgs.v2.i10.363.
Over the last two decades multiple studies have demonstrated an increased incidence of additional malignancies in patients with intraductal papillary mucinous neoplasms (IPMNs). Additional malignancies have been identified in 10%-52% of patients with IPMNs. The majority of these additional cancers occur before or concurrent with the diagnosis of IPMN. The gastrointestinal tract is most commonly involved in secondary malignancies, with benign colon polyps and colon cancer commonly seen in western countries and gastric cancer commonly seen in Asian countries. Other extrapancreatic malignancies associated with IPMNs include benign and malignant esophageal neoplasms, gastrointestinal stromal tumors, carcinoid tumors, hepatobiliary cancers, breast cancers, prostate cancers, and lung cancers. There is no clear etiology for the development of secondary malignancies in patients with IPMN. Although population-based studies have shown different results from single institution studies regarding the exact incidence of additional primary cancers in IPMN patients, both have reached the same conclusion: there is a higher incidence of extrapancreatic malignancies in patients with IPMNs than in the general population. This finding has significant clinical implications for both the initial evaluation and the subsequent long-term follow-up of patients with IPMNs. If a patient has not had recent colonoscopy, this should be performed during the evaluation of a newly diagnosed IPMN. Upper endoscopy should be performed in patients from Asian countries or for those who present with symptoms suggestive of upper gastrointestinal disease. Routine screening studies (breast and prostate) should be carried out as currently recommended for patient's age both before and after the diagnosis of IPMN.
在过去的二十年中，多项研究表明，患有胰管内乳头状黏液性肿瘤（IPMNs）的患者发生额外恶性肿瘤的发病率增加。在 10%-52%的 IPMN 患者中发现了额外的恶性肿瘤。这些额外的癌症大多数发生在 IPMN 诊断之前或同时。胃肠道最常发生继发性恶性肿瘤，西方国家常见良性结肠息肉和结肠癌，亚洲国家常见胃癌。与 IPMNs 相关的其他胰外恶性肿瘤包括良性和恶性食管肿瘤、胃肠道间质瘤、类癌肿瘤、肝胆癌、乳腺癌、前列腺癌和肺癌。IPMN 患者发生继发性恶性肿瘤的确切病因尚不清楚。尽管基于人群的研究与单一机构的研究在 IPMN 患者中额外原发性癌症的确切发病率方面得出了不同的结果，但两者都得出了相同的结论：与一般人群相比，IPMN 患者胰外恶性肿瘤的发病率更高。这一发现对 IPMNs 患者的初始评估和随后的长期随访都具有重要的临床意义。如果患者最近没有进行结肠镜检查，则应在新诊断的 IPMN 评估期间进行。对于来自亚洲国家的患者或有上消化道疾病症状的患者，应进行上消化道内镜检查。在诊断 IPMN 前后，应按照目前建议的患者年龄进行常规筛查研究（乳腺和前列腺）。
