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Intraductal papillary mucinous neoplasms of the pancreas showing fistula formation into other organs
- Source :
- Journal of Gastroenterology. 45:1080-1089
- Publication Year :
- 2010
- Publisher :
- Springer Science and Business Media LLC, 2010.
-
Abstract
- This study assessed the mechanism of fistula formation in intraductal papillary mucinous neoplasm (IPMN) of the pancreas.A total of 274 patients with IPMN who had been diagnosed by endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography (EUS) at our center were enrolled. The patients with IPMN which had fistula formation into other organs were investigated retrospectively as to (1) clinical prevalence and the organs penetrated by IPMN, (2) analysis of the mechanism of fistula formation by immunohistopathological study, (3) efficacy of EUS in progression assessment, and (4) prognosis.Among the subjects, fistula formation into other organs was observed in 18 patients (6.6%) and into 28 organs. There were 7 patients (39%) in whom multiple organs were penetrated. Of 16 patients who had undergone investigation of the expression of mucin markers, 94% had an intestinal-type tumor. Of 9 patients who had undergone surgery or autopsy, 67% showed mechanical penetration without invasion around the fistula. Only papillary protrusions were seen by EUS in 4 of these patients with noninvasive papillary adenocarcinoma showing mechanical penetration. All 5 patients who had pancreatic parenchymal invasion showed a mass with a mixed-echo pattern in addition to papillary protrusions shown by EUS, corresponding to colloid carcinoma.There were 2 processes in the development of fistulas in IPMN. Of those patients showing fistula formation, 94% had intestinal-type IPMN, and 67% showed mechanical penetration. Delineation of a mass with the mixed-echo pattern suggested an invasive penetration due to colloid carcinoma.
- Subjects :
- Male
medicine.medical_specialty
Pathology
endocrine system diseases
Fistula
Gastroenterology
Endosonography
Pancreatic Fistula
Surgical oncology
Internal medicine
Prevalence
medicine
Carcinoma
Humans
Aged
Retrospective Studies
Aged, 80 and over
Cholangiopancreatography, Endoscopic Retrograde
Intraductal papillary mucinous neoplasm
business.industry
Middle Aged
Hepatology
Prognosis
medicine.disease
Adenocarcinoma, Mucinous
Carcinoma, Papillary
Pancreatic Neoplasms
medicine.anatomical_structure
Pancreatic fistula
Adenocarcinoma
Female
business
Pancreas
Carcinoma, Pancreatic Ductal
Subjects
Details
- ISSN :
- 14355922 and 09441174
- Volume :
- 45
- Database :
- OpenAIRE
- Journal :
- Journal of Gastroenterology
- Accession number :
- edsair.doi.dedup.....617289fb3d99e83547a388eaaf66ec4f