诊断
通过组织病理学,IPMN在光学显微镜下的特征是粘液上皮细胞和胰管内的生长。粘蛋白5AC是有用的免疫组化标记。!!显微镜检查结果!显微照片!免疫组化标记物特征性遗传改变是KRAS和GNAS的遗传改变。IPMN的进一步子类型可以通过以下方式之一完成:大体病理:主导管与分支导管的病变,决定了手术管理通过光学显微镜和免疫组织化学:胃,肠,胰胆管和溶细胞。60岁男性胰腺切除远端标本中IPMN类型的组织病理学(通过大体病理学(中心图),显微镜和免疫组织化学检查):切除标本(c)显示MPD中的壁结节由PB型IPMN组成高度不典型增生(腺癌)(a),p53免疫染色(插入)和KRAS突变(G12V)弥散阳性。身体的BD-IPMN内衬着胃粘液样上皮,显示出低乳头状构型,轻度上皮分层,具有相同的KRAS突变(d),相似的胃IPMN组分的增殖依次累及壁结节的底部和壁的壁。周围膨胀的MPD(用红色箭头指示)(b)。尾巴的BD-IPMN内衬平坦的单层胃粘液上皮,缺乏细胞异型性和KRAS突变(e)。治疗
主动脉IPMN的首选治疗方法是切除,因为其恶性几率约为50%。有时用常规的CT或MRI监测侧支IPMN,但最终将其切除,在这些切除的肿瘤中,恶性率为30%。IPMN切除无恶性肿瘤后的5年生存率约为80%,恶性肿瘤为85%,但无淋巴结扩散,恶性肿瘤扩散为淋巴结为0%。手术可以包括切除胰头(胰十二指肠切除术),切除胰体和尾巴(远端胰切除术)或很少切除整个胰腺(全胰切除术)。在某些情况下,可以使用微创技术(例如腹腔镜或机器人手术)进行手术。一项使用监视,流行病学和最终结果登记表(SEER)数据的研究表明,在手术期间收获的淋巴结计数增加与侵袭性IPMN患者的存活率更高有关。历史
年,日本癌症研究基金会的大桥和彦(KazuhikoOhashi)将IPMN报告为“产生粘蛋白的肿瘤”。参考"IntraductalPapillaryMucinousNeoplasmsofthePancreas".JohnsHopkinsUniversity.Retrieved7September.Campbell,NM;Katz,SS;Escalon,JG;Do,RK(March)."Imagingpatternsofintraductalpapillarymucinousneoplasmsofthepancreas:anillustrateddiscussionoftheInternationalConsensusGuidelinesfortheManagementofIPMN".AbdominalImaging.40(3):–77.doi:10./s---4.PMID."Precancerousconditionsofthepancreas-CanadianCancerSociety".Retrieved5November.DianaAgostini-Vulaj."Pancreas-Exocrinetumors/carcinomas-Intraductalpapillarymucinousneoplasm(IPMN)".PathologyOutlines.TopicCompleted:1July.Revised:9MarchAdsay,Volkan;Mino-Kenudson,Mari;Furukawa,Toru;Basturk,Olca;Zamboni,Giuseppe;Marchegiani,Giovanni;Bassi,Claudio;Salvia,Roberto;Malleo,Giuseppe;Paiella,Salvatore;Wolfgang,ChristopherL.;Matthaei,Hanno;Offerhaus,G.Johan;Adham,Mustapha;Bruno,MarcoJ.;Reid,MichelleD.;Krasinskas,Alyssa;Kl#;ppel,Günter;Ohike,Nobuyuki;Tajiri,Takuma;Jang,Kee-Taek;Roa,JuanCarlos;Allen,Peter;Castillo,CarlosFernández-del;Jang,Jin-Young;Klimstra,DavidS.;Hruban,RalphH.()."PathologicEvaluationandReportingofIntraductalPapillaryMucinousNeoplasmsofthePancreasandOtherTumoralIntraepithelialNeoplasmsofPancreatobiliaryTract".AnnalsofSurgery.(1):–.doi:10./SLA..ISSN-.PMC.PishvaianMJ,BrodyJR()."TherapeuticImplicationsofMolecularSubtypingforPancreaticCancer".Oncology(WillistonPark).31(3):–66,.PMID.Salvia,Roberto()."Differencesbetweenmain-ductandbranch-ductintraductalpapillarymucinousneoplasmsofthepancreas".WorldJournalofGastrointestinalSurgery.2(10):.doi:10./wjgs.v2.i10..ISSN-.Ishida,Masaharu;Egawa,Shinichi;Aoki,Takeshi;Sakata,Naoaki;Mikami,Yukio;Motoi,Fuyuhiko;Abe,Tadayoshi;Fukuyama,Shoji;Sunamura,Makoto;Unno,Michiaki;Moriya,Takuya;Horii,Akira;Furukawa,Toru()."CharacteristicClinicopathologicalFeaturesoftheTypesofIntraductalPapillary-MucinousNeoplasmsofthePancreas".Pancreas.35(4):–.doi:10./mpa.0beda.ISSN-3.Shibata,Hideki;Ohike,Nobuyuki;Norose,Tomoko;Isobe,Tomohide;Suzuki,Reika;Imai,Hideyuki;Shiokawa,Akira;Takimoto,Masafumi;Tabuchi,Akihiro;Takano,Yuichi;Yamamura,Eiichi;Nagahama,Masatsugu;Takeyama,Nobuyuki;Yokomizo,Kazuaki;Mizukami,Hiroki;Tanaka,Jun-ichi;Aoki,Takeshi;Murakami,Masahiko()."Aresectedcaseoftwobranchduct-typeintraductalpapillarymucinousneoplasmsshowingdifferentclinicalcoursesafteratwo-yearfollow-up".ClinicalJournalofGastroenterology.10(3):–.doi:10./s---1.ISSN-.-"ThisarticleisdistributedunderthetermsoftheCreativeCommonsAttribution4.0InternationalLicense"Sohn,Taylor(June)."IntraductalPapillaryMucinousNeoplasmsofthePancreas".AnnalsofSurgery.(6):–.doi:10./01.sla...aa.PMC.PMID."PancreaticSurgery".JohnsHopkinsUniversity.Retrieved7September."LaproscopicPancreaticSurgery".JohnsHopkinsUniversity.Retrieved7September.Wu,WM(Sep2)."Anincreasedtotalresectedlymphnodecountbenefitssurvivalfollowingpancreasinvasiveintraductalpapillarymucinousneoplasmsresection:ananalysisusingthesurveillance,epidemiology,andendresultregistrydatabase".PLOSONE.9(9):e.doi:10./journal.pone.0.PMC.PMID.所有分享及看法仅限专业人士交流及参考
参考及图片等来源于网络,版权归原作者所有