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20220322 IPMN(胰腺导管内乳头状黏液肿瘤)
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IPMN Pathophysiology An IPMN represents a potentially malignant neoplasm arising from mucin-producing cells within the pancreatic ducts. As such, the excessive amounts of mucin produced enter and dilate the pancreatic ducts. IPMNs can arise from the side branches or the main pancreatic duct, with main duct being more high risk. Lesions may be low grade or indolent lesions, with possible progression to borderline, high-grade dysplasia and invasive carcinoma. Epidemiology IPMNs typically affect an older population, with individuals diagnosed between the ages of 50 to 70 years old. They have a slight female predominance, with studies reporting ratios from 2-to-1 to 3-to-1. Other associations include cigarette smoking, diabetes, family history of pancreatic cancers and genetic syndromes, which increase the risk of gastrointestinal malignancy, such as familial adenomatous polyposis syndrome. Clinical presentation Most patients have no symptoms at the time of diagnosis, with lesions detected on imaging for other reasons. Imaging features IPMNs on CT appear as cystic lesions, typically identified when they measure under 1 cm. They may have thin septations, but low-grade lesions should not have soft tissue components. They rarely calcify. Given their small size at detection, IPMNs are best evaluated on MR. They present as cystic lesions (high T2 signal) with no enhancement; any septations also should not demonstrate thickness, nodularity, or enhancement. Dilation of the main pancreatic duct, enhancement, and interval growth are high-risk stigmata that suggest malignant transformation. Treatment Most patients are treated conservatively, given the slow progression and low risk of malignant transformation. Follow-up can vary, as there is no clear guideline. Some (such as the Fukuoka guidelines) recommend cross imaging, preferably MR, every one to two years for 10 years to establish a benign pathophysiology. For those with enlarging lesions, main duct dilation, or new
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