Intraductal papillary mucinous tumor of pancreas (IPMT)

  • Most common cystic pancreatic neoplasm 
  • Arise from epithelial cells of main duct or side branches  
  • Produces large amount of mucin 
  • 4 histological types: dysplasia, borderline, carcinoma in situ, IPMT with invasive cancer 
  • Based on location: main duct type, branch duct type or mixed type  
  • Diffuse or segmental duct dilatation  
  • Mixed type shows diffuse and segmental duct dilatation 
  • Solid nodular protrusions or masses accompanying suggest malignancy 
  • Main duct lesions more likely to turn malignant and hence needs surgical resection 
  • Branch type < 3 cm in size needs only serial follow up in asymptomatic patients 
Fukuoka guidelines for treatment and follow up of IPMT 
  • Worrisome features: cyst ≥3 cm, enhancing mural nodules <5 mm, thick enhancing cyst wall, 5-9 mm caliber of main pancreatic duct, abrupt change in caliber of main pancreatic duct with upstream atrophy, lymphadenopathy, rapid cyst growth rate >5 mm/2 years 
  • High risk features: jaundice in a patient with cystic lesion of pancreatic head, enhanced mural nodule ≥5 mm and/or main pancreatic calibre ≥10 mm 
  • These patients have to undergo resection without further testing 
  • Fluid aspirate gives clue: high amylase favors pseudocyst. Mucinous neoplasms have high carcinoembryogenic antigen