PMID- 25081232 OWN - NLM STAT- MEDLINE DCOM- 20141121 LR - 20220318 IS - 1532-7361 (Electronic) IS - 0039-6060 (Print) IS - 0039-6060 (Linking) VI - 156 IP - 3 DP - 2014 Sep TI - Not all mixed-type intraductal papillary mucinous neoplasms behave like main-duct lesions: implications of minimal involvement of the main pancreatic duct. PG - 611-21 LID - S0039-6060(14)00193-7 [pii] LID - 10.1016/j.surg.2014.04.023 [doi] AB - BACKGROUND: The malignant potential of intraductal mucinous neoplasm of the pancreas (IPMN) is associated closely with main pancreatic duct (MPD) involvement. Because mixed-type IPMN is thought to have the same malignant potential as that of main-duct (MD)-IPMN, resection is recommended; however, the biological nature of mixed-type IPMN with only minimal involvement of MPD (min-mix-IPMN) may be different. METHODS: A prospective database of 404 resected IPMNs was re-reviewed to subclassify mixed-type IPMNs. We defined min-mix-IPMN as absence of gross abnormalities (except for dilatation) of MPD and noncircumferential microscopic involvement of MPD limited to few sections. RESULTS: We identified 46 min-mix-IPMNs, 163 IPMNs with extensive involvement of MPD (ex-mix-IPMN), 175 branch-duct (BD)-IPMNs, and 20 MD-IPMNs. The majority of min-mix-IPMNs were found incidentally and increased cyst size on surveillance was the leading operative indication. The median diameter of MPD was 2 mm in min-mix-IPMN versus 9 mm in ex-mix-IPMN (P < .0001), and cysts >/=10 mm were present in 62% of ex-mix-IPMNs versus 93% of min-mix-IPMNs (P < .0001). Most importantly, the vast majority of min-mix-IPMNs exhibited gastric-type epithelium, similar to BD-IPMNs, whereas intestinal-type epithelium was present in half of ex-mix-IPMNs, similar to MD-IPMNs. The prevalence of high-grade lesions was less in min-mix-IPMN than ex-mix-IPMN (P < .0001). These differences were reflected in better disease-specific outcomes of min-mix-IPMN compared with ex-mix-IPMN (P = .046). CONCLUSION: Min-mix-IPMN often presents with no MPD dilation and is an incidental finding by microscopic examination. min-mix-IPMN shares the pathologic features and less aggressive biology with BD-IPMN. We propose that min-mix-IPMN be categorized differently than ex-mix-IPMN. CI - Copyright (c) 2014 Mosby, Inc. All rights reserved. FAU - Sahora, Klaus AU - Sahora K AD - Department of Surgery, Massachusetts General Hospital, Boston, MA; Department of Surgery, Harvard Medical School, Boston, MA. FAU - Fernandez-del Castillo, Carlos AU - Fernandez-del Castillo C AD - Department of Surgery, Massachusetts General Hospital, Boston, MA; Department of Surgery, Harvard Medical School, Boston, MA. FAU - Dong, Fei AU - Dong F AD - Department of Pathology, Massachusetts General Hospital, Boston, MA. FAU - Marchegiani, Giovanni AU - Marchegiani G AD - Department of Surgery, Massachusetts General Hospital, Boston, MA; Department of Surgery, Harvard Medical School, Boston, MA. FAU - Thayer, Sarah P AU - Thayer SP AD - Department of Surgery, Massachusetts General Hospital, Boston, MA; Department of Surgery, Harvard Medical School, Boston, MA. FAU - Ferrone, Cristina R AU - Ferrone CR AD - Department of Surgery, Massachusetts General Hospital, Boston, MA; Department of Surgery, Harvard Medical School, Boston, MA. FAU - Sahani, Dushyant V AU - Sahani DV AD - Department of Radiology, Massachusetts General Hospital, Boston, MA; Department of Radiology, Harvard Medical School, Boston, MA. FAU - Brugge, William R AU - Brugge WR AD - Division of Gastroenterology, Massachusetts General Hospital, Boston, MA; Department of Internal Medicine, Harvard Medical School, Boston, MA. FAU - Warshaw, Andrew L AU - Warshaw AL AD - Department of Surgery, Massachusetts General Hospital, Boston, MA; Department of Surgery, Harvard Medical School, Boston, MA. FAU - Lillemoe, Keith D AU - Lillemoe KD AD - Department of Surgery, Massachusetts General Hospital, Boston, MA; Department of Surgery, Harvard Medical School, Boston, MA. FAU - Mino-Kenudson, Mari AU - Mino-Kenudson M AD - Department of Pathology, Massachusetts General Hospital, Boston, MA; Department of Pathology, Harvard Medical School, Boston, MA. Electronic address: mminokenudson@partners.org. LA - eng GR - P01 CA117969/CA/NCI NIH HHS/United States GR - P50 CA127003/CA/NCI NIH HHS/United States GR - R01 CA169086/CA/NCI NIH HHS/United States GR - CA117969/CA/NCI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20140728 PL - United States TA - Surgery JT - Surgery JID - 0417347 SB - IM MH - Adenocarcinoma, Mucinous/classification/pathology/surgery MH - Adult MH - Aged MH - Aged, 80 and over MH - Carcinoma, Pancreatic Ductal/classification/*pathology/surgery MH - Carcinoma, Papillary/classification/pathology/surgery MH - Female MH - Humans MH - Kaplan-Meier Estimate MH - Male MH - Middle Aged MH - Pancreatic Ducts/*pathology/surgery MH - Pancreatic Neoplasms/classification/*pathology/surgery PMC - PMC5614499 MID - NIHMS821007 EDAT- 2014/08/02 06:00 MHDA- 2014/12/15 06:00 PMCR- 2017/09/26 CRDT- 2014/08/02 06:00 PHST- 2013/11/07 00:00 [received] PHST- 2014/04/14 00:00 [accepted] PHST- 2014/08/02 06:00 [entrez] PHST- 2014/08/02 06:00 [pubmed] PHST- 2014/12/15 06:00 [medline] PHST- 2017/09/26 00:00 [pmc-release] AID - S0039-6060(14)00193-7 [pii] AID - 10.1016/j.surg.2014.04.023 [doi] PST - ppublish SO - Surgery. 2014 Sep;156(3):611-21. doi: 10.1016/j.surg.2014.04.023. Epub 2014 Jul 28.