IS Case 132: Intraductal Papillary Mucinous Tumor of the Pancreas

Daniel Ginat, MD

Imaging Sciences URMC 2008
Publication Date: 2009-05-21

History

Patient is a 58-year-old male with history of liver cirrhosis of uncertain etiology, pancreatic cancer, and diagnosis of intraductal papillary mucinous tumor of the pancreas based on outside institution work-up.

Findings

CT: A 5.0 x 4.0 cm complex cystic lesion with adjacent solid component within the tail of the pancreas. MRI: Complex cystic mass at the tail of the pancreas. Pancreatic duct is not dilated.

Discussion

Cystic neoplasms of the pancreas are uncommon entities. These include serous microcystic adenoma, mucinous cystadenomas, intraductal papillary mucinous tumor (IPMT), solid pseudopapillary tumor, cystic endocrine tumors, cystic metastases, cystic teratomas, and lymphangiomas. IPMT consists of ductal epithelium proliferation associated with ductal dilatation and variable mucin production.

Various morphologies of IPMT have been described: segmental or diffuse involvement of the main pancreatic duct and macrocystic or microcystic involvement of a branch duct. Protrusion of the papilla into the duodenum is apparently pathognomonic of IPMT on CT and MRI.

It is estimated that 25 to 44% of cases of IPMT are associated with invasive carcinoma. Findings that suggest the presence of carcinoma include a solid mass or mural nodule, severe pancreatic dilatation, multifocal involvement, and common bile duct obstruction.

For most cases of IMPT, the treatment of choice is surgical resection. Noninvasive IPMTs feature indolent growth and have a recurrence rate of 5 to 10%, while invasive tumors have a prognosis similar to adenocarcinoma.

References

  1. Prasad SR, Sahani D, Nasser S, et al. Intraductal papillary mucinous tumors of the pancreas. Abdom Imaging. 2003 May-Jun;28(3):357-65. [PMID: 12719906]
  2. Kawamoto S, Horton KM, Lawler LP, Hruban RH, Fishman EK. Intraductal papillary mucinous neoplasm of the pancreas: can benign lesions be differentiated from malignant lesions with multidetector CT? Radiographics. 2005 Nov-Dec;25(6):1451-68; discussion 1468-70. [PMID: 16284127]

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