Intraductal papillary or mucinous tumors (IPMT) of the pancreas: Report ofa case series and review of the literature

OBJECTIVE: Despite a better understanding of these conditions, intraductal papillary or mucinous tumors (IPMT) of the pancreas still present difficult y relating to the predictive factors of malignancy and the risk of relapse after surgical resection. The aim of this study was to report on our experi ence and to compare it to previously published cases. METHODS: We studied retrospectively 26 patients (mean age 60.3 yr) presenti ng with IPMT. Of the 26 patients, 19 had surgical resection and seven did n ot. The main clinical feature was acute pancreatitis occurring in 38% of th e patients. Segmental pancreatectomy was performed in all the cases. At pat hological assessment of resection margins, tumor resection was considered a s complete in 17 cases. Margins exhibited benign mucinous involvement, and resection was considered to be incomplete in one multifocal case and in one case with diffuse spread of the tumor. RESULTS: A total of Il tumors were benign and five were malignant. Carcinom as were invasive in four cases (two invading the pancreatic parenchyma, one the duodenum, and one the peripancreatic nodes) and in situ in one case. M alignancy was not diagnosed preoperatively except when invasion was evident (duodenal spread). Although main pancreatic duct type and obstructive jaun dice appeared as suggestive features for the risk of malignancy, no reliabl e preoperative predictive factors for malignancy could be identified as reg arding to clinical parameters, biological examinations, carcinoembryonic an tigen or CA19-9 levels in serum or in pure pancreatic juice, imaging, and c ytological methods. Within 40.8 months mean follow-up after surgery (range 2-96 months), three patients (16%), two with malignant and one with benign tumor, had tumor relapse after respectively 7, 27, and 14 months. Margins w ere positive without malignant features in the two malignant cases and nega tive in the other case. Turner relapse was malignant with diffuse spreading in the three cases, and the patients died within 34 months after surgical resection. CONCLUSIONS: Our series and the review of the literature indicate that preo perative indicators of malignancy in IPMT are still lacking. Concerning res ection margins, complete tumor resection is usually possible by segmental p ancreatectomy. Malignant relapses are not exceptional. Incomplete resection and diffuse or multifocal tumor represent poor prognostic factors. Total p ancreatectomy should be considered in such cases. (C) 2001 by Am. Cell. of Gastroenterology.