Marchegiani Giovanni, Mino-Kenudson Mari, Sahora Klaus, Morales-Oyarvide Vicente, Thayer Sarah, Ferrone Cristina, Warshaw Andrew L, Lillemoe Keith D, Fernández-Del Castillo Carlos
Departments of *Surgery; and †Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Ann Surg. 2015 May;261(5):976-83. doi: 10.1097/SLA.0000000000000813.
To describe the characteristics of intraductal papillary mucinous neoplasms (IPMNs) with predominant involvement of the main pancreatic duct (MPD), analyzing predictors for survival and recurrence.
IPMNs involving the MPD harbor a high likelihood of malignancy and different biological features. The appropriateness of including cases with minimal noncircumferential MPD involvement has been challenged because these show clinicopathological features that are similar to branch duct IPMN. Accordingly, their exclusion has led to a redefinition of MPD IPMN (MD-IPMN).
Retrospective review of resected MD-IPMN from 1990 to 2013. All slides were reviewed by a single pancreatic pathologist and classified on the basis of epithelial type and invasive component.
A total of 223 patients underwent resection for IPMN involving the MPD. Of these, 50 were excluded because of minimal MPD involvement. Among the 173 patients analyzed, median age was 68 years and 55% were males. Predominant epithelial phenotype was intestinal (50%). Forty-eight patients (28%) had low- or intermediate-grade dysplasia, whereas 125 (72%) had either high-grade dysplasia (33%) or invasive carcinoma (39%). Of the 67 invasive IPMNs, 39 were tubular carcinomas (58%) and invasion was minimal (<5 mm) in 28 (42%). The 5-year overall survival rate was 69% and the disease-specific survival rate was 83%. The estimated recurrence rate at 10 years was 25%. Size and type of the invasive component, lymph node positivity, and a positive resection margin were predictors for both survival and recurrence (P < 0.05).
MD-IPMN is mainly intestinal-type and malignant. After resection, it has a very favorable prognosis, especially in the absence of macroscopic invasive carcinoma.
描述以主胰管（MPD）受累为主的导管内乳头状黏液性肿瘤（IPMN）的特征，分析生存和复发的预测因素。
累及MPD的IPMN具有较高的恶性可能性和不同的生物学特征。将非环周性MPD受累程度较轻的病例纳入其中是否合适受到了质疑，因为这些病例表现出与分支导管IPMN相似的临床病理特征。因此，将它们排除导致了MPD IPMN（MD-IPMN）的重新定义。
回顾性分析1990年至2013年接受手术切除的MD-IPMN病例。所有切片均由一名胰腺病理学家进行复查，并根据上皮类型和浸润成分进行分类。
共有223例患者因IPMN累及MPD接受了手术切除。其中，50例因MPD受累程度较轻而被排除。在分析的173例患者中，中位年龄为68岁，55%为男性。主要上皮表型为肠型（50%）。48例患者（28%）为低级别或中级别异型增生，而125例（72%）为高级别异型增生（33%）或浸润性癌（39%）。在67例浸润性IPMN中，39例为管状癌（58%），28例（42%）浸润程度较轻（<5mm）。5年总生存率为69%，疾病特异性生存率为83%。估计10年复发率为25%。浸润成分的大小和类型、淋巴结阳性以及手术切缘阳性是生存和复发的预测因素（P<0.05）。
MD-IPMN主要为肠型且具有恶性特征。切除术后预后良好，尤其是在无肉眼可见浸润性癌的情况下。
