Vol. 30, pp.11 17, 2002 AFIP 2 4 IPMT IPMT. Mucinous Cystic Tumor: MCT. Intraductal Papillary Mucinous Tumor: IPMT

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1 Vol. 30, pp.11 17, % AFIP IPMT IPMT IPMT Mucinous Cystic Tumor: MCT 1996 WHO AFIP 2 Intraductal Papillary Mucinous Tumor: IPMT % 11

2 1 IPMT 1 IPMT 1 MCT 2 3 Solid and cystic tumor 4 5 IPMT 7 1 ERCP IPMT 8 IPMT CT 8 9 IPMT US CT EUS 90% 10 EUS 10 2 MRCP 10 4 mm ERCP 1 MRCP 2 12

3 2 IPMTMCT IPMT MCT K-ras IPMT K-ras 11 IPMT K-ras 45% K-ras 3 ras K-ras, N-ras, H- ras 12 CEA CA19-9 IPMT MCT 2MCT US CT 78.9% % 10 ERCP % 2 3 IPMT 15 IPMT IPMT 13

4 3 IPMT 4 IPMT MUC-2 MUC-2, 48 2 MCT 4 2 intestinal type pancreatobiliary type 16 4 IPMT 14

5 3 Muc-1 glycoprotein MUC-1 Muc-2 glycoprotein MUC-2 Muc-5AC glycoprotein MUC-5AC Muc-6 AC glycoprotein MUC-6AC Small intestinal mucinous antigen SIMA Human gastric mucin HGM IPMT IPMT IPMT k-ras IPMT 40 60% K-ras IPMT 18 SMAD4 SMAD4 IPMT Oncogene products c-erb-b-2 IPMT IPMT P53 IPMT borderline malignancy 3 MUC-1 MUC-2 MUC-5AC HGM MUC-6AC IPMT IPMT IPMT MUC-2, MUC-5AC MUC-1 HGM IPMT MUC-1 IPMT SIMA hyperplasia IPMT CEA EMA CA-19-9 hyperplasia HGM MUC-6AC 22 IPMT MUC-1 IPMT MUC-1 MUC-2 MUC-5AC 15

6 2 MUC-2 MUC-5AC 21 MCT solid and cystic tumor MCT MCT MCT ER PGR Calretinin IPMT 23 solid and cystic tumor centroacinar cell IPMT IPMT 1 IPMT IPMT 2 1 IPMT IPMT 3 28 IPMT IPMT 5 78% % 25 IPMT 5 96% 92% 89% 73% 56% IPMT 1 1,,,. 4. Prog Ig Endosc 1982; 20: Solcia E, Capella C and Kloppel G. Tumors of the pancres. Atlas of Tumor Pathology, AFIP, Washinton DC, 1997: , 4,,, Kloppel G, Solcia E and Lougnecker DS. Histological typing of the exocrine pancreas. International Histological Classification of Tumors, 2nd ed., World Health Organization, Springer, Berlin, 1996: ; 10:

7 ; 14: Fukushima N and Mukai K. Pancreatic neoplasms with abundant mucus production; Empashis on intraductal papillary-mucinous tumors and mucinous cystic tumors. Adv Anat Pathol 1999; 6: ,,, ; 14: ,,, ; 83: ,,. IPMT US, EUS. 2000; 21: Hara T, Yamaguchi T, Ishihara T, Tsuyuguchi T and Kondo F. Diagnosis and patient management of intraductal papillary-mucinous tumor of the pancreas by using peroral pancreatoscopy and intraductal ultrasonography. Gastroenterology 2002; 12: ,, ; 18: Tada M, Omata M and Kawai S. Detection of ras gene mutations in pancreatic juice and peripheral blood of patients with pancreatic adenocarcinoma. Cancer Res 1993; 53: ,,. MCT,. 2001; 22: Traverso LW, Ryan JAJ and Kozarek RA. Intraductal neoplasms of the pancreas. Am J Surg 1988; 175: Adsay NV, Coulon KC, Zee SY, Brennan MF and Klimstra DS. Intraductal papillary-mucinous neoplasms of the pancreas. Cancer 2002; 94: Paal E, Thompson LDR and Przygodziki RM. A clinicopathologic and immunohistochemical study of 22 intraductal papillary mucinous neoplasms of the pancreas,with a review of the literature. Mod Pathol 1999; 12: Tada M, Omata M and Ohto M. Ras gene mutations in intraductal papillary neoplasm of the pancreas. Cancer 1991; 67: Fukushige S, Furukawa T, Satoh K, Sunamura M, Kobari M and Koizumi M. Loss of chromosome 18q is an early event in pancreatic ductal tumorigenesis. Cancer Res 1998; 58: Luttges J, Zamboni G and Longnecker D. The immunohistochemical mucin expression pattern distinguishes different types of IPMN of the pancreas and determines their relationship to mucinous noncystic carcinoma and ductal adenocarcinoma. Am J Surg Pathol 2001; 25: Yonezawa S, Horinouchi M, Osako M, Arimura Y, Nagata K, Tanaka S and Sakoda K. Gene expression of gastric type mucin MUC5AC in pancreatic tumor: Its relationship with the biological behavior of the tumor. Pathology International 1999; 49: Balague C, Audie J-P, Porchet N and Real FX. In situ hybridization shows distinct patterns of mucin gene expression in normal benign, and malignant pancreatic tissues. Gastroenterology 1995; 109: Zamboni G, Scarpa A and Bogina G. Mucinous cystic tumor of the pancreas: Clinicopathologic features, and relationship to other mucinous cystic tumors. Am J Surg Pathol 1999; 23: Thompson LDR, Becker RC and Przygodzki RM. Mucinous cystic neoplasm Mucinous cystadenocarcinoma of low-grade malignant potential of the pancreas. A clinicopathologic study of 130 cases. Am J Surg Pathol 1999; 23: , ; 18: ,,. Intraductal papillary-mucinous tumor. 2000; 21: ,,, ; 3: Cuiller E, Cellier C and Palazzo L. Out-come after surgical resection of intraductal papillary and mucinous tumors of the pancreas. Am J Gastroenterol 2000; 95:

CLINICAL MANAGEMENT OF INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS OF THE PANCREAS

1 CLINICAL MANAGEMENT OF INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS OF THE PANCREAS Carlos Fernández-del Castillo, M.D. Associate Professor of Surgery Massachusetts General Hospital Harvard Medical School,