Mod Pathol  1999 May;12(5):518-28 

A clinicopathologic and immunohistochemical study of 22 intraductal papillary
mucinous neoplasms of the pancreas, with a review of the literature.

Paal E, Thompson LD, Przygodzki RM, Bratthauer GL, Heffess CS.

American Registry of Pathology, Washington, DC, USA.

Intraductal papillary-mucinous neoplasms (IPMNs) of the pancreas are rare
lesions. We undertook this study to analyze these tumors by focusing on the
diagnostic criteria and correlating the histologic features with clinical
prognosis. Twenty-two cases of IPMN were retrieved from the Endocrine Tumor
Registry of the Armed Forces Institute of Pathology. Blocks or unstained slides
were available for histochemical and immunohistochemical studies (including
proliferative markers and cell cycle regulators) and K-ras oncogene mutations in
15 cases. Patient follow-up was obtained in all of the cases. IPMN occurs in
both genders with a slight male predominance, with a mean age at presentation of
64.4 years (range, 48-85 yr). The patients presented with abdominal pain. The
neoplasms were radiologically and grossly cystic, usually (18 cases of 22)
located in the head of the pancreas. Histologically, the tumors consisted of
intraductal papillary proliferations protruding into and expanding the
pancreatic ducts. Invasion into the surrounding pancreatic parenchyma was
detected in 15 cases. Chronic pancreatitis was present in all of the cases. p27
immunoreactivity always exceeded the immunoreactivity of cyclin E. K-ras
oncogene mutations were detected in two cases. Patients were treated with a
complete surgical resection (n = 7) or a Whipple procedure (n = 13). Only 2 of
22 patients died of disease (3 died immediately postoperatively and 3 died of
unrelated causes), whereas the remaining 14 patients were alive at last
follow-up, without evidence of disease, an average of 58.2 months after initial
presentation. IPMNs are rare, distinctive neoplasms, with complex intraductal
papillae, that can be easily separated from in situ ductal adenocarcinoma and
mucinous cystic neoplasms. The high ratio of p27 protein to cyclin E supports
the excellent prognosis of these neoplasms, despite the presence of invasion and
K-ras oncogene mutation.

Publication Types:
Review
Review Literature

PMID: 10349991 [PubMed - indexed for MEDLINE]