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Clinical Implication of Morphological Subtypes in Management of Intraductal Papillary Mucinous Neoplasm

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Morphological subtypes of intraductal papillary mucinous neoplasm (IPMN) have been established. Invasive IPMNs include colloid carcinoma and tubular carcinoma. Few studies have explored the association between the morphological and invasive subtypes in a large population. Clinical relevance of the morphological subtypes remains unclear.

Methods

One hundred sixty-nine consecutive patients who underwent curative resection of IPMN were enrolled. The intraductal components were classified into four distinct epithelial subtypes: gastric, intestinal, pancreatobiliary, and oncocytic. The invasive components were classified as colloid or tubular.

Results

The numbers of patients with gastric, intestinal, pancreatobiliary, and oncocytic subtypes were 123, 42, 3, and 1, respectively. Fifty-six patients had invasive cancer (tubular type, 42; colloid type, 14). The proportions of gastric type IPMN within each histological grade were 88 % among adenomas, 43 % among noninvasive carcinomas, 41 % among minimally invasive carcinomas, and 74 % among invasive carcinomas. Gastric subtype was more commonly associated with branch duct type and intestinal subtype with main duct type, and these tendencies were statistically significant (P = 0.0131). Furthermore, there was a strong correlation between gastric and tubular types and between intestinal and colloid types (P < 0.0001). The 5-year survival rate among the 56 invasive cancers was 52.7 % for gastric type and 89.7 % for intestinal type, which was statistically significant (P = 0.030).

Conclusions

Gastric type IPMN is mostly derived from branch duct IPMN and often demonstrates benign behavior, as seen with adenomas. However, once gastric type IPMN develops into invasive carcinoma, the survival rate is significantly lower than other types.

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Disclosure

Suguru Yamada, Tsutomu Fujii, Tsutomu Fujii, Mitsuro Kanda, Goro Nakayama, Hiroyuki Sugimoto, Masahiko Koike, Shuji Nomoto, Michitaka Fujiwara, Akimasa Nakao, and Yasuhiro Kodera have nothing to disclose.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan

    Suguru Yamada MD, PhD, FACS, Tsutomu Fujii MD, PhD, FACS, Mitsuro Kanda MD, PhD, Goro Nakayama MD, PhD, Hiroyuki Sugimoto MD, PhD, Masahiko Koike MD, PhD, Shuji Nomoto MD, PhD, Michitaka Fujiwara MD, PhD & Yasuhiro Kodera MD, PhD, FACS

  2. Department of Pathology, Nagoya University Hospital, Nagoya, Aichi, Japan

    Yoshie Shimoyama MD, PhD

  3. Department of Surgery, Nagoya Central Hospital, Nagoya, Aichi, Japan

    Akimasa Nakao MD, PhD, FACS

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  1. Suguru Yamada MD, PhD, FACS
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  2. Tsutomu Fujii MD, PhD, FACS
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  3. Yoshie Shimoyama MD, PhD
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  4. Mitsuro Kanda MD, PhD
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  6. Hiroyuki Sugimoto MD, PhD
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  7. Masahiko Koike MD, PhD
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  8. Shuji Nomoto MD, PhD
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Correspondence to Suguru Yamada MD, PhD, FACS.

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Yamada, S., Fujii, T., Shimoyama, Y. et al. Clinical Implication of Morphological Subtypes in Management of Intraductal Papillary Mucinous Neoplasm. Ann Surg Oncol 21, 2444–2452 (2014). https://doi.org/10.1245/s10434-014-3565-1

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  • DOI: https://doi.org/10.1245/s10434-014-3565-1

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