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WHO Classification of Tumours
Intraductal papillary mucinous neoplasm (IPMN) with high-grade dysplasia
Pancreas


Definition

A non-invasive malignant intraductal epithelial neoplasm arising from the main pancreatic duct or its major branches. Signs and symptoms include epigastric pain, weight loss, jaundice, diabetes, and pancreatitis. It is composed of columnar mucin-containing cells which line dilated ducts and form papillary or pseudopapillary structures. The columnar cells show severe dysplasia. The reported survival rates are high.

Proposed definition:
Intraductal papillary mucinous neoplasmas (IPMNs) are intraductal grossly-visible (typically ≥ 1.0 cm) epithelial neoplasms of mucin producing cells, arising in the main pancreatic duct or its branches

Click to access Pubmed
Hruban RH, Takaori K, Klimstra DS, Adsay NV, Albores-Saavedra J, Biankin AV, Biankin SA, Compton C, Fukushima N, Furukawa T, Goggins M, Kato Y, Kloppel G, Longnecker DS, Lüttges J, Maitra A, Offerhaus GJ, Shimizu M, Yonezawa S (2004)
An illustrated consensus on the classification of pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasms.
Am J Surg Pathol 28: 977-87




Click to access Pubmed
Tanaka M, Chari S, Adsay V, Fernandez-del Castillo C, Falconi M, Shimizu M, Yamaguchi K, Yamao K, Matsuno S, (2006)
International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas.
Pancreatology 6: 17-32



. Signs and symptoms include epigastric pain, weight loss, jaundice, diabetes, and pancreatitis. The neoplastic epithelium is usually papillary, and the degrees of mucin secretion, duct dilatation (cyst formation), and dysplasia are variable. IPMNs are classified on the basis of the highest degree of cytoarchitectural atypia and invasiveness as:
> IPMN with low- to intermediate-grade of dysplasia , previously called intraductal papillary-mucinous adenoma
> IPMN with high grade of dysplasia, previously called intraductal papillary-mucinous carcinoma, non-invasive
> IPMN with an associated invasive carcinoma if there is a component of invasive carcinoma.

In case of IPMN with high grade of dysplasia, dysplastic changes in the columnar cells are severe. The reported survival rates are high.

Commentary: Preneoplastic lesions of the digestive system