Korean J Gastroenterol.  2009 Sep;54(3):162-166. 10.4166/kjg.2009.54.3.162.

Extrapancreatic Tumors in Intraductal Papillary Mucinous Neoplasm of the Pancreas

• Oh SJ
• Lee SJ
• Lee HY
• Paik YH
• Lee DK
• Lee KS
• Chung JB
• Yu JS
• Yoon DS

• KMID: 1775952
• DOI: http://doi.org/10.4166/kjg.2009.54.3.162

Abstract

BACKGROUND/AIMS
Intraductal papillary mucinous neoplasm (IPMN) of the pancreas has a favorable prognosis, but seems to be associated with a high incidence of extrapancreatic tumors. The purpose of this study was to evaluate the incidence and clinicopathological features of extrapancreatic tumors associated with IPMN. METHODS: Thirty-seven patients with IPMN of the pancreas, confirmed by surgical resection and typical findings of endoscopic ultrasonography and CT imaging between October 1, 1998 and August 31, 2006 were included. Seventeen patients were diagnosed with surgical resection and biopsy, and others by typical imaging findings of IPMN. These patients were examined for the development of extrapancreatic tumors. RESULTS: Of 37 patients with IPMN, 14 (38%) had 18 extrapancreatic tumors, and 10 (27%) had 13 extrapancreatic malignancies. Five, six, and two extrapancreatic malignancies had diagnosed before during, and after the diagnosis of IPMN. Gastric adenocarcinoma (3 patients, 23%) and colorectal carcinoma (3 patients, 23%) were the most common neoplasms. Other extrapancreatic tumors included lung cancer (n=2), prostatic cancer (n=1), renal cell carcinoma (n=1), cholangiocelluar carcinoma (n=1), urinary bladder cancer (n=1), and gallbladder cancer (n=1), respectively. As benign tumor, there were two gallbladder adenoma, one gastric adenoma, one colonic adenoma and one benign ovarian cystic neoplasm, respectively. CONCLUSIONS: IPMN is associated with high incidence of extrapancreatic tumors, particularly gastric and colorectal neoplasms. Upper gastrointestinal endoscopy and colonoscopy should be done, and systemic surveillance for the possible occurrence of other tumors may allow early detection of extrapancreatic tumor in patients with IPMN.

Keyword

Intraductal papillary mucinous neoplasm (IPMN); Pancreas; Extrapancreatic tumors

MeSH Terms

Adenocarcinoma, Mucinous/*diagnosis/pathology/ultrasonography
Adult
Aged
Aged, 80 and over
Carcinoma, Pancreatic Ductal/*diagnosis/pathology/ultrasonography
Carcinoma, Papillary/*diagnosis/pathology/ultrasonography
Female
Humans
Incidence
Male
Middle Aged
Neoplasms, Multiple Primary/diagnosis/*epidemiology
Neoplasms, Second Primary/diagnosis/*epidemiology
Pancreatectomy
Pancreatic Neoplasms/*diagnosis/pathology/ultrasonography
Retrospective Studies
Tomography, X-Ray Computed

Reference

1. Kimura W, Sasahira N, Yoshikawa T, Muto T, Makuuchi M. Duct-ectatic type of mucin producing tumor of the pancreas-new concept of pancreatic neoplasia. Hepatogastroenterology. 1996; 43:692–709.

2. Rickaert F, Cremer M, Deviere J, et al. Intraductal mucin-hypersecreting neoplasm of the pancreas. A clinicopathologic study of eight patients. Gastroenterology. 1991; 101:512–519.

3. Warshaw AL, Compton CC, Lewandrowski K, Cardenosa G, Mueller PR. Cystic tumors of the pancreas: new clinical, radiologic, and pathologic observations in 67 patients. Ann Surg. 1990; 212:432–443.

4. Loftus EV Jr, Olivares-Pakzad BA, Batts KP, et al. Intraductal papillary-mucinous tumors of the pancreas: clinicopathologic features, outcome, and nomenclature. Gastroenterology. 1996; 110:1909–1918.

5. Sugiyama M, Atomi Y, Kuroda A. Two types of mucin-producing cystic tumors of the pancreas: diagnosis and treatment. Surgery. 1997; 122:617–625.

6. Suzuki Y, Atomi Y, Sugiyama M, et al. Cystic neoplasm of the pancreas: a Japanese multiinstitutional study of intraductal papillary mucinous tumor and mucinous cystic tumor. Pancreas. 2004; 28:241–246.

7. Sugiyama M, Atomi Y. Extrapancreatic neoplasms occur with unusual frequency in patients with intraductal papillary mucinous tumors of the pancreas. Am J Gastroenterol. 1999; 94:470–473.

8. Yamaguchi K, Yokohata K, Noshiro H, Chijiiwa K, Tanaka M. Mucinous cystic neoplasm of the pancreas or intraductal papillary-mucinous tumor of the pancreas. Eur J Surg. 2000; 166:141–148.

9. Kamisawa T, Tu Y, Egawa N, Nakajima H, Tsuruta K, Okamoto A. Malignancies associated with intraductal papillary mucinous neoplasm of the pancreas. World J Gastroenterol. 2005; 11:5688–5690.

10. Tanaka M. Intraductal papillary mucinous neoplasm of the pancreas: diagnosis and treatment. Pancreas. 2004; 28:282–288.

11. Seo WT, Lee SJ, Chung JP, et al. A case of intraductal papillary mucinous tumor of the pancreas accompanied by gastric cancer. Korean J Gastrointest Endosc. 2000; 21:877–881.

12. Coleman CN, Langer M. Late complications of cancer therapy. Moossa AR, editor. ed.Comprehensive textbook of oncology. 2nd ed.Baltimore: Williams and Wilkins;1991. p. 1802–1807.

13. Tucker MA, Caggana M, Kelsey K, et al. Secondary cancers. Holland JF, editor. ed.Cancer medicine. 3rd ed.Philadelphia: Lea and Febiger;1993. p. 2402–2415.

14. Tada M, Omata M, Ohto M. Ras gene mutations in intraductal papillary neoplasms of the pancreas. Analysis in five cases. Cancer. 1991; 67:634–637.

15. Benhatter J, Losi L, Chaubert P, Givel JC, Costa J. Prognostic significance of Kras mutations in colorectal carcinoma. Gastroenterology. 1993; 104:1044–1048.

16. Sessa F, Solcia E, Capella C, et al. Intraductall papillary- mucinous tumours represent a distinct group of pancreatic neoplasms: an investigation of tumour cell differentiation and Kras, p53 and c-erbB-2 abnormalities in 26 patients. Vir-chows Arch. 1994; 425:357–367.

17. Satoh K, Shimosegawa T, Moriizumi S, Koizumi M, Toyota T. Kras mutations and p53 protein accumulation in intraductal mucin-hypersecreting neoplasms of the pancreas. Pancreas. 1996; 12:362–368.

18. Z'graggen K, Rivera JA, Compton CC, et al. Prevalence of activating Kras mutations in the evolutionary stages of neoplasia in intraductal papillary mucinous tumors of the pancreas. Ann Surg. 1997; 226:491–498.

19. Chetty R, Salahshor S, Bapat B, Berk T, Croitoru M, Gallinger S. Intraductal papillary mucinous neoplasm of the pancreas in a patient with attenuated familial adenomatous polyposis. J Clin Pathol. 2005; 58:97–101.