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Natural History of Branch Duct Intraductal Papillary-Mucinous Neoplasms of the Pancreas without Mural Nodules: Long-term Follow-up Results
  1. Satoshi Tanno (tanno1se{at}asahikawa-med.ac.jp)
  1. Asahikawa Medical College, Japan
    1. Yasuhiro Nakano
    1. Asahikawa Medical College, Japan
      1. Tomoya Nishikawa
      1. Asahikawa Medical College, Japan
        1. Kazumasa Nakamura
        1. Asahikawa Medical College, Japan
          1. Junpei Sasajima
          1. Asahikawa Medical College, Japan
            1. Madoka Minoguchi
            1. Asahikawa Medical College, Japan
              1. Yusuke Mizukami
              1. Asahikawa Medical College, Japan
                1. Nobuyuki Yanagawa
                1. Asahikawa Medical College, Japan
                  1. Tsuneshi Fujii
                  1. Asahikawa Medical College, Japan
                    1. Takeshi Obara
                    1. Asahikawa Medical College, Japan
                      1. Toshikatsu Okumura
                      1. Asahikawa Medical College, Japan
                        1. Yutaka Kohgo
                        1. Asahikawa Medical College, Japan

                          Abstract

                          Background and aim: Although branch duct intraductal papillary-mucinous neoplasms (IPMNs) of the pancreas without mural nodules were frequently observed in asymptomatic subjects, the natural history of these lesions has never been studied. The aim of this study was to elucidate the natural history of branch duct IPMNs without mural nodules.

                          Methods: Eighty-two patients who had no apparent mural nodules on initial examination were selected for follow-up. All subjects underwent examinations by imaging modalities including endoscopic retrograde pancreatography, and were followed up by regular examinations once or twice a year. Serial changes of the maximum cystic diameter and the appearance of mural nodules were studied during the observation periods ranging from 14 to 148 months (median, 61 months).

                          Results: Nine (11.0%) of 82 patients exhibited obvious progression of cystic dilatation (median, 59 months). Of nine patients with cystic enlargement, six continued with regular follow-up examinations. Three cases underwent surgical resection and were pathologically diagnosed as adenoma in two and borderline in one. Four patients (4.9%) showed newly developed mural nodules in dilated branch ducts (median, 105 months). Histologic analysis revealed three cases classified as adenoma and one as carcinoma in situ. None of the remaining 69 patients (84.1%) showed any

                          Conclusions: Most branch duct IPMNs without mural nodules remained unchanged during long-term follow-up. Although follow-up with careful examination is required to detect newly developed mural nodules in dilated branch duct, branch duct IPMNs without mural nodules can be followed up without surgery.

                          • branch duct
                          • follow-up
                          • intraductal papillary-mucinous neoplasm
                          • natural history
                          • pancreas

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