Intraductal Papillary Mucinous Neoplasms (IPMN)
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Pancreas Disease Center -
Intraductal Papillary Mucinou…
What are intraductal papillary mucinous neoplasms?
Intraductal papillary mucinous neoplasm (IPMN) is a cystic tumor that grows within the pancreatic ducts and is composed of mucin-producing cells. IPMN has the potential to progress to an invasive cancer. The progression in the tissues is described as low grade dysplasia, intermediate grade dysplasia and high grade dysplasia. Intermediate to high grade dysplasia is recognized as the stage at which removal of the pancreas is recommended.
Our approach
Northwell Health has a team of clinicians dedicated to the treatment of pancreatic cysts, including IPMN. Learn more about our approach to care or find a pancreatic cyst expert.
Our team of pancreas experts are here to help with pancreatitis, pancreatic cysts and pancreatic cancer.
Symptoms
There are often no symptoms of IPMN, and they are usually found incidentally during an imaging test for something else. Other times, IPMN symptoms may include:
- Pancreatitis (an estimated 30 percent of patients with IPMN have pancreatitis)
- Abdominal or back pain
- Nausea/vomiting
- Jaundice (a yellowing of the skin or eyes)
- Weight loss
- Fever
- Steatorrhea (abnormal amounts of fat in the stools)
How is it diagnosed?
IPMN are mostly diagnosed through imaging techniques, including:
- CT scan
- Abdominal ultrasound
- Endoscopic ultrasound with fine needle aspiration
- MRI (magnetic resonance imaging)
- Magnetic resonance cholangiopancreatography (MRCP)
- ERCP with pancreatoscopy
Types of treatment
IPMN may involve the main pancreatic duct, the branch ducts or both. Patients with main duct IPMN are at a higher risk for developing malignancy than those with branch duct IPMN.
Main duct IPMN treatment
For main duct IPMN, surgical resection is generally the treatment of choice, since the chance of malignancy is about 50 to 70 percent. Surgery includes the removal of the head of the pancreas (pancreaticoduodenectomy), or the body and tail of the pancreas (distal pancreatectomy)—or in rare cases, the removal of the entire pancreas (a total pancreatectomy). In select cases, surgery can be performed using minimally invasive techniques, such as laparoscopy or robotic surgery.
Branch duct IPMN treatment
Branch duct IPMN are less likely to lead to malignancy, but they are premalignant. They are not usually resected unless they continue to grow at a rapid rate, reach a diameter of 3 cm or they have other associated high-risk features, such as nodules within the cyst and various components of the fluid within the cyst. Patients with branch duct IPMN must be closely monitored for the development of these signs with regular CT scans, MRI/MRCP, or endoscopic ultrasound. We offer a coordinated pattern of follow-up for our patients in this category.
What to expect after treatment
Although highly debated over past years, it is now undisputed that surveillance should continue for life for all patients with IPMN – including those who haven't yet needed surgical treatment and those who have undergone resection of either benign or malignant IPMN.