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Clinicopathological Features of Malignant Intraductal Papillary Mucinous Tumors of the Pancreas
The Differential Diagnosis From Benign Entities
Manabu Kawai, MD;
Kazuhisa Uchiyama, MD;
Masaji Tani, MD;
Hironobu Onishi, MD;
Hiroyuki Kinoshita, MD;
Masaki Ueno, MD;
Takashi Hama, MD;
Hiroki Yamaue, MD
Arch Surg. 2004;139:188-192.
Background The accurate differential diagnosis of malignant intraductal papillary mucinous tumors (IPMTs) of the pancreas from benign IPMTs remains unclear.
Hypothesis Predictive factors for differentiating malignant IPMTs from benign IPMTs can be documented.
Design Retrospective study (1999-2003).
Setting Wakayama Medical University Hospital, Wakayama, Japan.
Patients Twenty-seven consecutive patients with IPMTs (11 with adenoma, 3 with dysplasia, 5 with adenocarcinoma, and 8 with invasive adenocarcinoma) who underwent surgery were retrospectively analyzed in terms of clinicopathological features.
Main Outcome Measure Clinical data, preoperative imaging findings, cytology, and tumor marker level, including carcinoembryonic antigen (CEA) and carbohydrate antigen (CA19-9), in serum and pure pancreatic juice.
Results In preoperative imaging findings, the mean tumor size for the malignant IPMT group (81 ± 18 mm) was significantly larger than that for the benign IPMT group (31 ± 4 mm) (P = .002). The mean mural nodule size for the malignant IPMT group (9.8 ± 4.4 mm) was significantly larger than that for the benign IPMT group (3.3 ± 5.7 mm) (P = .002). The CEA levels in pure pancreatic juice in the malignant IPMT group (3051 ± 7556 ng/mL) were significantly higher than in the benign IPMT group (41 ± 80 ng/mL) (P = .003), although no significant differences in cytologic analyses and CA19-9 levels in pure pancreatic juice were found between the 2 groups.
Conclusion Our findings suggest that tumor size larger than 30 mm, mural nodule size larger than 5 mm, and CEA levels higher than 110 ng/mL in pure pancreatic juice were predictive factors for diagnosis of malignant IPMTs.
From the Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan.
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