Intraductal Papillary Mucinous Tumor of the Pancreas

The intraductal papillary mucinous tumor (IPMT, formerly also called ductectatic cystadenoma or ductectatic cystadenocarcinoma) of the pancreas is a rare tumor that is considered a subtype of the mucinous cystic neoplasms of the pancreas. IPMT can be classified as main duct, branch duct (side-branch) or mixed type, depending on the site and extent of involvement [37]. The cystic changes always demonstrate a connection to the pancreatic duct, a diagnostic feature that can be seen on MDCT and MRI. The branch duct tumor consists of cystic dilation of the side branches of the pancreatic duct, usually in the uncinate process. These ducts are lined with atypical, hyperplastic or clearly malignant epithelium. In the late stages, the tumor nodules of the ducts produce copious mucinous secretions, which fill the entire duct. In branch duct IPMT the overall prognosis is good because extension into the parenchyma and beyond occurs relatively late and overall malignant degeneration is rare. Malignancy is present in 25-44% of resected specimens of the other two types. Resection is therefore the treatment of choice in these patients.

CT shows markedly dilated ducts and cystic-appearing structures filled with mucinous material, which has slightly higher attenuation than that of water. MRI can detect the higher signal intensity of mucin on T1-weight-ed sequences. MRI appears to have a slight advantage over CT because it can visualize the internal architecture of the lesion slightly better than CT, including a solid mass and mural nodules, which are signs of malignancy. EUS also is well suited to detect mural nodules.

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