First Department of Surgery, Yamagata University School of Medicine, Yamagata, Japan.
Pancreas. 2012 Jan;41(1):114-20. doi: 10.1097/MPA.0b013e318220c1fa.
Intraductal papillary mucinous neoplasms (IPMNs) are pathologically classified as IPMN with low- or intermediate-grade dysplasia, IPMN with high-grade dysplasia, and IPMN with an associated invasive carcinoma. A stepwise carcinogenic pathway has been considered for IPMN. However, it is not obvious when surgical resection should be performed for IPMN.
We studied the MIB-1 labeling index in cases of IPMN and ordinary ductal adenocarcinoma (ODA). Moreover, IPMN with an associated invasive carcinoma was divided into 2, namely, carcinoma in situ and invasive components, and the respective MIB-1 labeling indexes were examined.
The MIB-1 labeling index for IPMN with low- or intermediate-grade dysplasia (1.8%) was significantly lower than those for IPMN with high-grade dysplasia (14.2%), both the carcinoma in situ components (23.1%) and invasive components (19.2%) within the IPMN with an associated invasive carcinoma, and ODA (19.5%; P < 0.0001).The 5-year survival rates after resection were 100% for IPMN with low- or intermediate-grade dysplasia, 83.3% for IPMN with high-grade dysplasia, 53.8% for IPMN with an associated invasive carcinoma, and 10.3% for ODA.
MIB-1 might be useful for the classification of malignant potential in IPMN. Intraductal papillary mucinous neoplasm should be surgically resected when the tumor is diagnosed as IPMN with high-grade dysplasia.
导管内乳头状黏液性肿瘤（IPMN）在病理学上可分为低级别或中级别异型增生的 IPMN、高级别异型增生的 IPMN 和伴有浸润性癌的 IPMN。人们认为 IPMN 存在一个逐步癌变的途径。然而，对于何时应进行手术切除 IPMN 并不明确。
我们研究了 IPMN 和普通导管腺癌（ODA）病例中的 MIB-1 标记指数。此外，将伴有浸润性癌的 IPMN 分为原位癌和浸润性成分，并分别检查其 MIB-1 标记指数。
低级别或中级别异型增生的 IPMN（1.8%）的 MIB-1 标记指数明显低于高级别异型增生的 IPMN（14.2%）、伴有浸润性癌的原位癌成分（23.1%）和浸润性成分（19.2%）以及 ODA（19.5%）（P<0.0001）。切除后的 5 年生存率分别为低级别或中级别异型增生的 IPMN 为 100%、高级别异型增生的 IPMN 为 83.3%、伴有浸润性癌的 IPMN 为 53.8%、ODA 为 10.3%。
MIB-1 可能有助于对 IPMN 的恶性潜能进行分类。当肿瘤被诊断为高级别异型增生的 IPMN 时，应进行手术切除。
