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A new approach to managing intraductal papillary mucinous pancreatic neoplasms
  1. Paula Ghaneh,
  2. John Neoptolemos
  1. Division of Surgery and Oncology, School of Cancer Studies, University of Liverpool, Royal Liverpool University Hospital, Liverpool L69 3GA, UK
  1. Correspondence to:
    Professor J P Neoptolemos
    Division of Surgery and Oncology, School of Cancer Studies, University of Liverpool, Royal Liverpool University Hospital, 5th Floor UCD Building, Daulby Street, Liverpool L69 3GA, UK; j.p.neoptolemos{at}liverpool.ac.uk

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Progress in the diagnosis and management plan for this pancreatic neoplasm

A large prospective study by Salvia et al1 published in this issue of Gut shows that a follow-up protocol for branch duct intraductal papillary mucinous neoplasms (IPMNs) appears feasible and safe (see page 1086). IPMNs of the pancreas were originally described in a number of case reports and short series of patients in the early 1990s,2,3 and mucinous cystic neoplasms of the pancreas had been reported in the 1980s.4–6 In 1996 the World Health Organisation (WHO) revised the criteria for the pathological diagnosis of IPMN,7 thus allowing the differentiation of IPMN from other mucinous/cystic neoplasms of the pancreas. This meant that a number of “different” neoplasms could now come under the single diagnostic umbrella of IPMN (table 1).

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Table 1

 Classification and characteristics of intraductal papillary mucinous neoplasms (IPMNs)

The apparent incidence of IPMN has increased dramatically over the past 10–15 years and now represents up to 10–20% of the pancreatic resection workload of specialist units.8 This is due in part to improved imaging techniques, greater recognition of this clinicopathological entity and a larger number of asymptomatic patients undergoing cross-sectional imaging.9

Histologically, IPMNs progress along a pathway from adenoma to borderline IPMN with dysplasia to IPMN with carcinoma in situ and eventually to invasive carcinoma. It is not always possible to differentiate high-grade and low-grade lesions on imaging alone, and the time to progression is not known. The association of IPMNs (particularly the gastric type variant) with the precursor lesions of pancreatic ductal adenocarcinoma known as pancreatic intra-epithelial neoplasms (PanINs) or PanIN-like lesions may provide further information concerning their development.10,11 Molecular analysis may provide biomarkers of disease progression in the near future with further follow-up of patients with characterised lesions. The …

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