View source for Intraductal papillary mucinous tumour

'''Intraductal papillary mucinous tumour''', abbreviated '''IPMT''', is an uncommon tumour of the [[pancreas]].

It is also known as '''intraductal papillary mucinous neoplasm''' (abbreviated '''IPMN''').

==General==
*Morphologically and biologically distinct from ductal adenocarcinoma, mucinous cystic tumour and ductal papillary hyperplasia.
*Prognosis: 
**Favourable if caught early; not much different than ductal adenocarcinoma if caught late.<ref name=pmid12377813>{{cite journal |author=Maire F, Hammel P, Terris B, ''et al.'' |title=Prognosis of malignant intraductal papillary mucinous tumours of the pancreas after surgical resection. Comparison with pancreatic ductal adenocarcinoma |journal=Gut |volume=51 |issue=5 |pages=717–22 |year=2002 |month=November |pmid=12377813 |pmc=1773420 |doi= |url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=12377813}}</ref>
**Dependent what is involved:<ref name=pmid20374620>{{cite journal |author=Baiocchi GL, Portolani N, Missale G, ''et al.'' |title=Intraductal papillary mucinous neoplasm of the pancreas (IPMN): clinico-pathological correlations and surgical indications |journal=World J Surg Oncol |volume=8 |issue= |pages=25 |year=2010 |pmid=20374620 |pmc=2858722 |doi=10.1186/1477-7819-8-25 |url=http://wjso.com/content/8/1/25}}</ref>
***Main duct (bad prognosis).
***Branch (good prognosis).

Clinical:
*Patient usually not jaundiced... as no obstruction.
*Often diabetes... as pancreas is destroyed.
*Patients may get a total pancreatectomy - as the disease is often multifocal.

====Epidemiology====
*~1% of all exocrine pancreatic tumours.
*More common in males.
*Mean age at presentation 62 years.
*60-80% occur in the head of the pancreas.
*Average size 4 cm.

===Classification of IMPT===
Commonly classified by the duct involvement:<ref name=pmid20397268>{{Cite journal  | last1 = Ikeuchi | first1 = N. | last2 = Itoi | first2 = T. | last3 = Sofuni | first3 = A. | last4 = Itokawa | first4 = F. | last5 = Tsuchiya | first5 = T. | last6 = Kurihara | first6 = T. | last7 = Ishii | first7 = K. | last8 = Tsuji | first8 = S. | last9 = Umeda | first9 = J. | title = Prognosis of cancer with branch duct type IPMN of the pancreas. | journal = World J Gastroenterol | volume = 16 | issue = 15 | pages = 1890-5 | month = Apr | year = 2010 | doi =  | PMID = 20397268 PMC = 2856831 | URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2856831/}}</ref>
#Main duct type.
#*Commonly associated with invasive carcinoma.
#Branch duct type.
#*Less commonly associated with invasive carcinoma.

=====Behaviour=====
*Adenoma.
*Borderline mucinous tumour.
*Carcinoma.

Notes:
*Borderline tumours are rare.
*If intralobular dilated ducts... carcinoma.
*Any margin with mucin cells in thought to be badness!

==Gross==
*May be patchy/multifocal.
*Multiple cystic spaces.

==Microscopic==
Features:
*Pancreatic duct lining cells jut into the duct lumen - papillomatous growth pattern.
*Cytology:
**Cell enlargement.
***Increased mucin production.
**Nuclear changes:
***Increased [[NC ratio]].
***Nuclear crowding and [[nuclear pleomorphism|pleomorphism]].
**Mitotic activity.

Note:
*No ovarian type stroma underneath (as seen in mucinous tumours).

DDx:
*[[PanIN]].
*[[Invasive ductal carcinoma of the pancreas]].
*Intra-ampullary papillary-tubular neoplasm -- see ''[[ampulla of Vater]]''.

==See also==
*[[Pancreas]].

==References==
{{Reflist|1}}
[[Category:Pancreas]]
[[Category:Diagnosis]]