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World J Gastrointest Surg. Oct 27, 2010; 2(10): 319-323
Published online Oct 27, 2010. doi: 10.4240/wjgs.v2.i10.319
Intraductal papillary mucinous neoplasm and the pancreatic incidentaloma
Tara S Kent, Charles M Vollmer Jr, Mark P Callery
Tara S Kent, Charles M Vollmer Jr, Mark P Callery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
Author contributions: Kent TS did the literature search and primary writing; revisions were done by Vollmer Jr CM and Callery MP.
Correspondence to: Tara S Kent, MD, Division of General Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Stoneman 9th Floor, Boston, MA 02215, United States. tkent@bidmc.harvard.edu
Telephone: +1-781-4533650 Fax: +1-781-4533652
Received: May 18, 2010
Revised: September 28, 2010
Accepted: October 5, 2010
Published online: October 27, 2010
Abstract

Asymptomatic pancreatic lesions (APL) are a commonly encountered problem in today’s pancreatic surgical practices. Current literature regarding etiologies and incidence of APLs, particularly intraductal papillary mucinous neoplasm (IPMN), is presented. APLs constitute a wide spectrum of pathology (solid/cystic, benign/premalignant/malignant) but, overall, IPMN is now the most common diagnosis. The Sendai Guidelines and their function as a basis for risk stratification in branch duct IPMN are presented. The importance of traditionally analyzed cyst characteristics including size, presence of mucin or nodules and cyst fluid aspirate as indicators of malignancy is emphasized, noting also the potential correlation of main duct dilatation, thickened septae and elevated cyst fluid CEA with increased risk of malignancy. Current complication rates after resection of APLs are reviewed and found to be generally equivalent to those for symptomatic resections. A potential multidisciplinary treatment strategy is offered considering the costs of surgery versus repeated imaging or follow up endoscopy for these lesions. The decision for intervention is ultimately based on the Sendai Guidelines in the context of the individual patient.

Keywords: Intraductal papillary mucinous neoplasm; Pancreatic incidentaloma; Surveillance; Observation