IPMN - Intraductal Tumors

What is IPMN?

IPMN, an acronym for Intraductal Papillary Mucinous Neoplasm, is a cause of pancreatitis in which there is a transformation of the cells that line the pancreatic duct into premalignant cells —cells that display characteristics that may develop into pancreatic cancer— that produce mucous and block off the pancreatic duct.

These cells appear as long strands, and secrete a thick mucus. They may be benign, but evidence shows that these cells often become cancerous, and invasive, in many people. This condition can involve the entire pancreatic duct or it may involve just a small segment of the pancreas.

Most cases of IPMN occur in the side-branches of the papillary ducts, and there is a very low mortality rate for these tumors.

Symptoms

Symptoms may include:

• abdominal pain, nausea, and vomiting
• jaundice
• pancreatitis and inflammation

Diagnosis

Diagnostic techniques that may be used to detect IPMN are:

• CT scan — a computed tomography scanner that takes many X-ray images from different angles to produce cross-sectional images
• MRI/MRCP — a painless, magnetic imaging technique
• endoscopic ultrasound — a minimally invasive procedure that can visualize tissue
• EUS-FNA — a minimally invasive procedure that collects tissue (biopsy) for examination by a pathologist

Treatment

Possible treatment options for invasive IPMN, depending on the degree of involvement of the pancreas, may include:

• Whipple procedure — removal of the head of the pancreas
• Distal pancreatectomy — removal of the tail of the pancreas
• Central pancreatectomy — resection of the middle of the pancreas, saving its head and tail
• Total pancreatectomy — removal of the entire pancreas
• Minimal surgical resection of noninvasive IPMN (i.e. confined to the pancreatic duct) has an excellent prognosis.

The reason why surgery is the established treatment is because a large percentage of people with IPMN have, or will develop, cancer.