Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan; Department of Pathology and Laboratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan.
Department of Pathology and Laboratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan.
Pancreatology. 2020 Oct;20(7):1379-1385. doi: 10.1016/j.pan.2020.08.006. Epub 2020 Aug 17.
BACKGROUND/OBJECTIVES: Intraductal papillary mucinous neoplasms (IPMNs) are classified into main duct (MD)-type IPMNs, branch duct (BD)-type IPMNs, and mixed type IPMNs. While MD-type IPMN has a high risk of malignancy and should therefore be considered for resection if the patient is fit, BD-type IPMN needs to be carefully judged for surgical indication. The decision to resect BD-type IPMN is often based on international consensus Fukuoka guidelines 2017, but further investigation is required. In this study, we focused on whether the location of the mural nodule (MN) could be an indicator of malignancy.
We enrolled 17 cases who had been diagnosed BD-type IPMNs which were surgically resected from January 2016 to December 2019. These cases were classified into benign and malignant group. Subsequently, a clinicopathological study was conducted based on the localization of MN (MN-central type or MN-peripheral type).
Although MN was found in 57% (4/11) in the benign group, 88% (7/8) was noted in the malignant group, indicating the presence of MN to be more common in the malignant group. Those with MN consisted of 6 cases of MN-central type and 5 cases of MN-peripheral type. All cases of central type were malignant compared to only one case of the peripheral group being confirmed on histology as cancer.
BD-IPMN with central mural nodule should be considered high risk for malignancy.
背景/目的：导管内乳头状黏液性肿瘤（IPMNs）分为主胰管（MD）型、分支胰管（BD）型和混合性 IPMN 型。MD 型 IPMN 恶性风险高，如果患者适合，应考虑切除；BD 型 IPMN 需要仔细判断手术适应证。切除 BD 型 IPMN 的决定通常基于国际共识福冈指南 2017，但需要进一步研究。本研究关注壁结节（MN）的位置是否可以作为恶性的指标。
我们纳入了 2016 年 1 月至 2019 年 12 月手术切除的 17 例 BD 型 IPMN 患者。这些病例分为良性和恶性组。随后，根据 MN 的位置（MN 中央型或 MN 周围型）进行临床病理研究。
虽然良性组中 57%（4/11）存在 MN，但恶性组中 88%（7/8）存在 MN，表明恶性组中 MN 更为常见。MN 组包括 6 例 MN 中央型和 5 例 MN 周围型。中央型的所有病例均为恶性，而周围型仅 1 例组织学证实为癌症。
BD-IPMN 伴中央壁结节应被视为高度恶性肿瘤。
