Intraductal papillary neoplasm of the pancreas

Controversies about both the term for and clinicopathologic entity of the intraductal papillary neoplasm of the pancreas still exist. The incidence of this tumor is rare, with only a few cases reported in the literature. Four cases of intraductal papillary adenocarcinoma of the pancreas, treated at the Veterans General Hospital-Taipei, between January 1985 and December 1994 were re-viewed retrospectively. The age, sex, size, tumor location, clinical presentation, pathology and prognosis were re-evaluated for each patient. All patients were male, aged from 63 to 79 years. Tumor sizes varied from 2.5 to 6 cm, and all were located in the head of the pancreas. The most common presentations were weight loss, epigastric pain, and jaundice. Grossly, these appeared as papillary soft tumors occluding the main pancreatic duct, with well-differentiated, mucin-secreting, columnar epithelial cells along the dilated pancreatic ducts. Three patients, who had received pylorus-preserving pancreaticoduodenectomy (PPPD), survived with a mean follow-up of 22.7 months (range: 18-30 months). The other patient was unresectable, but received a bypass operation with a survival of 19.5 months. The intraductal papillary neoplasm is a unique clinicopathological entity compared with mucinous cystic neoplasm and classic duct adenocarcinoma of the pancreas. Clinically, the typical endoscopic retrograde cholangiopan-creaticographic (ERCP) findings, plus a cystic mass in the pancreatic head found by ultrasound or CT scans should lead to the diagnosis of intraductal papillary neoplasm of the pancreas. Aggressive surgical procedure should be attempted for this mucin- producing neoplasm with low-grade malignancy.