review of literature on clinical pancreatology - The Pancreapedia

adenocarcinoma must be addressed at follow-up evaluation. A follow-up managementalgorithm also was also proposed in the <strong>review</strong> [578]Risk <strong>of</strong> cancerAlthough branch duct intraductal papillary mucinous neoplasms (BD-IPMNs) are slowgrowingtumors with a favorable prognosis, the synchronous occurrence <strong>of</strong> pancreatic ductaladenocarcinomas (PDAs) in patients with BD-IPMNs has been reported. One study wasaimed to elucidate the development <strong>of</strong> PDAs in long-term follow-up patients with BD-IPMNs.It was investigated 89 BD-IPMN patients who had no mural nodules and followed them upconservatively at least 2 years (median follow-up, 64 months; range, 25-158 months). Allsubjects underwent examinations by imaging modalities including endoscopic retrogradepancreatography. It was calculated the standardized incidence ratio (SIR) from vital statistics.Among the 89 patients, 4 cases <strong>of</strong> PDAs distant from BD-IPMN were observed in 552patient-years <strong>of</strong> follow-up (7.2 per 1000 patient-years). The expected number was 0.25, andthe SIR <strong>of</strong> PDAs was 15.8 (95 % confidence interval 4.3 to 40.4). Subgroup analysesshowed that the incidence <strong>of</strong> PDAs was significantly increased in patients 70 years or older(SIR 16.7; 95 % confidence interval 3.4 to 48.7) and in women (SIR 22.5; 95 % confidenceinterval 2.7 to 81.1). It was concluded that patients with BD-IPMNs are at a high risk forpancreatic adenocarcinomas. During the follow-up, careful examination is required to detectthe development <strong>of</strong> PDAs in patients with BD-IPMNs [579].The biologic and clinical behavior <strong>of</strong> intraductal papillary mucinous neoplasms <strong>of</strong> thepancreas (IPMNs) and IPMN-associated adenocarcinomas is different from ductal pancreaticcancer in having a less aggressive tumor growth and significantly improved survival. Up todate, the molecular mechanisms underlying the clinical behavior <strong>of</strong> IPMNs are incompletelyunderstood. Now 128 cystic pancreatic lesions were prospectively identified during thecourse <strong>of</strong> 2 years. From the corresponding surgical specimens, 57 IPMNs were separatedand subdivided by histologic criteria into those with low-grade dysplasia, moderate dysplasia,high-grade dysplasia, and invasive cancer. Twenty specimens were suitable for DNAisolation and subsequent performance <strong>of</strong> array CGH. While none <strong>of</strong> the IPMNs with lowgradedysplasia displayed detectable chromosomal aberrations, IPMNs with moderate andhigh-grade dysplasia showed frequent copy number alterations. Commonly lost regions werelocated on chromosome 5q, 6q, 10q, 11q, 13q, 18q, and 22q. The incidence <strong>of</strong> loss <strong>of</strong>chromosome 5q, 6q, and 11q was significantly higher in IPMNs with high-grade dysplasia orinvasion compared with PDAC. Ten <strong>of</strong> 13 IPMNs with moderate dysplasia or malignancy hadloss <strong>of</strong> part or all <strong>of</strong> chromosome 6q, with a minimal deleted region between linear positions78.0 and 130.0. This study is the first to use array CGH to characterize IPMNs. Recurrentcytogenetic alterations were identified and were different than those described in PDAC.Array CGH may help distinguish between these 2 entities and give insight into thedifferences in their biology and prognosis [580].A 52-year-old man with a history <strong>of</strong> distal gastrectomy for gastric cancer was admittedbecause <strong>of</strong> jaundice. CT scan revealed double tumors in the pancreatic head and bodyconcomitant with multicystic lesions <strong>of</strong> the pancreas. Total pancreatectomy with splenectomyand remnant gastrectomy was performed. Final histological diagnosis was double invasiveductal carcinomas <strong>of</strong> the pancreas head and tail with multifocal branch duct intraductalpapillary mucinous adenomas <strong>of</strong> the pancreas. The present case suggests that entirepancreas might have malignant potential in patients with intraductal papillary mucinousneoplasms [581].A consensus conference has recommended close observation <strong>of</strong> branch duct intraductalpapillary mucinous neoplasms (BD-IPMNs) smaller than 30 mm, without symptoms or muralnodules. One study investigated whether these recommendations could be validated in a