Neoplasia papilar intraductal mucinosa de páncreas
Palabras clave:
neoplasias pancreáticas, papilloma, intraductal, carcinoma papilar, cistadenoma mucinoso, diagnósticoResumen
La neoplasia papilar intraductal de páncreas es una entidad poco frecuente, raramente invasiva, de bajo potencial de malignización, de presentación poco típica y, generalmente, asintomática, que afecta la cola o el cuerpo pancreático y en muchas oportunidades es un hallazgo incidental en estudios de imágenes, como la ecografía abdominal y la tomografía.
El estudio de la lesión puede realizarse de diferentes maneras, como la tomografía o la colangiografía endoscópica para estudio imaginológico y la aspiración del líquido pancreático para el estudio citológico y de marcadores tumorales. La ultrasonografía endoscópica y la colangiorresonancia permiten obtener datos más aproximados para el diagnóstico de esta lesión y para la definición del manejo, el cual en la mayoría de los casos consiste en la realización de resección quirúrgica con biopsia intraoperatoria por congelación.
Se presenta el caso de un paciente con cáncer papilar intraductal de páncreas y se hace una revisión sobre este tema.
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Referencias bibliográficas
1. BRUGGE WR, LAUWERS GY, SAHANI D, FERNÁNDEZ-DEL CASTILLO C, WARSHAW AL. Cystic neoplasms of the pancreas. N Engl J Med. 2004;351:1218-26.
2. EGUCHI H, ISHIKAWA H, OHIGASHI T, SASAKI Y, YAMADA T, NAKAIZUMI A, UEHARA H, TAKENAKA A, KASUGAI T, IMAOKA S. Role of intraoperative cytology combined with histology in detecting continuous and skip type intraductal cancer existence for intraductal papillary mucinous carcinoma of the pancreas. Cancer. 2006;107:2567-75.
3. WARSHAW AL, BRUGGE WR, LEWANDROWSKI K. Case 35-2003: a 75-year-old man with a cystic lesion of the pancreas. N Engl J Med. 2003;349:1954-61.
4. MICHAELS PJ, BRACHTEL EF, BOUNDS BC, BRUGGE WR, PITMAN MB et al. Intraductal papillary mucinous neoplasm of the pancreas cytologic features predict histologic grade. Journal American Cancer Society. 2006;108:163-73.
5. LONGNECKER DS, HRUBAN RH, ADLER G, KLOPPEL G. Intraductal papillary-mucinous neoplasms of the pancreas. In: Hamilton SR, Aaltonen LA, editors. World Health Organization classification of tumours. Pathology and genetics of tumours of the digestive System. Lyon: IARC Press; 2000. p. 237-40.
6. KLÖPPEL G, SOLCIA E, LONGNECKER DS, CAPELLA C, SOBIN LH. Histological typing of tumours of the exocrine pancreas. International histological classification of tumours. New York: Springer-Verlag; 1996:15-21.
7. D’ANGELICA M, BRENNAN MF, SURIAWINATA AA, KLIMSTRA D, CONLON KC. Intraductal papillary mucinous neoplasms of the pancreas: an analysis of clinicopathologic features and outcome. Ann Surg. 2004;239:400-8.
8. GALINDO F, KOGAN Z. Tumores quísticos del páncreas. Rev Argent Cir. 1998; 75:140-50.
9. MORAL A, MARGAZO J, MUÑOZ CH, HERNÁNDEZ A, GONZÁLEZ JA et al. Neoplasia papilar intraductal mucinosa del páncreas. Revista Órgano Oficial de la Asociación Española de Cirujanos 2005;77:258-62.
10. FAJARDO R, QUINTERO G. Tumor papilar intraductal mucinoso del páncreas. Rev Colomb Cir. 2002;17:31-6.
11. KIM SY, LEE JM, KIM SH, SHIN KS, KIM YJ, AN SK, et al. Macrocystic neoplasms of the pancreas: CT differentiation of serous oligocystic adenoma from mucinous cystadenoma and intraductal papillary mucinous tumor. AJR. 2006;187:1192-8.
12. FLORES E, FLORES ME, FLORES DM, DELGADO M, et al. Tumores quísticos del páncreas. Archivo Médico de Camagüey. 2007;11(2). Abril 16, 2008; www.amc.sld.cu/amc/2007/v11n2- 2007/2163.htm
13. TANNO S, NAKANO Y, NISHIKAWA T, NAKAMURA K, SASAJIMA J, MINOGUCHI M, et al. Natural history of branch duct intraductal papillary mucinous neoplasms of the pancreas without mural nodules: long term follow-up results. Gut. 2008 Mar; 57(3):339- 43. Epub 2007 Jul 27 Gut. 2008; Mar; 57(3):339-43. Epub 2007, Jul 27.
14. YAMAO K, OHASHI K, NAKAMURA T, SUZUKI T, SHIMIZU Y, NAKAMURA Y, et al. The prognosis of intraductal papillary mucinous tumors of the pancreas. Hepatogastroenterology. 2000;47:1129-34.
15. HOLGUÍN F, LONDOÑO E. Tumor quístico del páncreas. Rev Colomb Cir. 1991;6:87-90.
16. SALVIA R, FERNÁNDEZ-DEL CASTILLO C, BASSI C, THAYER SP, FALCONI M, MANTOVANI W, et al. Main-duct intraductal papillary mucinous neoplasms of the pancreas: clinical predictors of malignancy and long-term survival following resection. Ann Surg. 2004;239:678-85.
17. QUENTIN V, RIOUX-LECLERCQ N, PAGENAULT M, OLIVIÉ D, CAMPION JP, GOSSELIN M, et al. Accuracy of preoperative imaging methods in a retrospective series of 14 patients with operated intraductal papillary mucinous tumors of the pancreas. Gastroenterol Clin Biol. 2005;29:150-5.
18. YEH TS, TSENG JH, CHIU CT, LIU NJ, CHEN TC, JAN YY, et al. Cholangiographic spectrum of intraductal papillarymucinous neoplasm of the bile ducts. Ann Surg. 2006;244:248-53.
19. HARA T, YAMAGUCHI T, ISHIHARA T, TSUYUGUCHI T, KONDO F, KATO K, et al. Diagnosis and patient management of intraductal papillary-mucinous tumor of the pancreas by using peroral pancreatoscopy and intraductal ultrasonography. Gastroenterology. 2002;122:34-43.
20. SOHN TA, YEO CJ, CAMERON JL, HRUBAN RH, FUKUSHIMA N, CAMPBELL KA, et al. Intraductal papillary mucinous neoplasms of the pancreas an updated experience. Ann Surg. 2004;239:788- 99.
21. YAMAGUCHI K, NAKAMURA M, SHIRAHANE K, KAWAMOTO M, KONOMI H, OHTA M, et al. Pancreatic juice cytology in IPMN of the pancreas. Pancreatology. 2005;5:416-21.
22. FALCONI M, SALVIA R, BASSI C, ZAMBONI G, TALAMINI G, PEDERZOLI P. Clinicopathological features and treatment of intraductal papillary mucinous tumour of the pancreas. Br J Surg. 2001;88:376-81.
23. LAU SK, LEWANDROWSKI KB, BRUGGE WR, WARSHAW AL, CENTENO BA. Diagnostic significance of mucin in fine needle aspiration samples of pancreatic cysts. Mod Pathol. 2000;13:48A.
24. CHUNG RS, CHURCH JM, VAN STOLK R. Pancreas-sparing duodenectomy: indications, surgical technique, and results. Surgery. 1995;117:254-9.
25. ISHIKAWA O, OHIGASHI H, NAKAMORI S, SASAKI Y, FURUKAWA H, IMAOKA S, et al. Three-segmental cytodiagnosis using balloon catheter for locating occult carcinoma of the pancreas. J Am Coll Surg. 1995;180:353-5.
26. BASSI C, CRIPPA S, SALVIA R. Intraductal papillary mucinous neoplasms (IPMNs): is it time to (sometimes) spare the knife? Gut. 2008 Mar; 57(3):287-9.
27. EISENBERGER CF, KNOEFEL WT, PEIPER M, YEKEBAS EF, HOSCH SB, BUSCH C, et al. Pancreas-sparing duodenectomy in duodenal pathology: indications and results. Hepatogastroenterology. 2004;51:727-31.
28. CAMERON JL, PITT HA, YEO CJ, LILLEMOE KD, KAUFMAN HS, COLEMAN J. One hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Ann Surg. 1993;217:430-5.
29. CHARI ST, YADAV D, SMYRK TC, DIMAGNO EP, MILLER LJ, RAIMONDO M, et al. Study of recurrence after surgical resection of intraductal papillary mucinous neoplasm of the pancreas. Gastroenterology. 2002;123:1500-7.
30. ADSAY NV, CONLON KC, ZEE SY, BRENNAN MF, KLIMSTRA DS. Intraductal papillary-mucinous neoplasms of the pancreas: an analysis of in situ and invasive carcinomas in 28 patients. Cancer. 2002;94:62-77.
31. LOFTUS EV JR, OLIVARES-PAKZAD BA, BATTS KP, ADKINS MC, STEPHENS DH, SARR MG, BATTS KP, et al. Intraductal papillarymucinous tumors of the pancreas: clinicopathologic features, outcome, and nomenclature. Gastroenterology. 1996;110:1909- 18.
32. COUVELARD A, SAUVANET A, KIANMANESH R, HAMMEL P, COLNOT N, LÉVY P, et al. Frozen sectioning of the pancreatic cut surface during resection of intraductal papillary mucinous neoplasms of the pancreas is useful and reliable: a prospective evaluation. Ann Surg. 2005;242:774-8.
33. BIANKIN AV, KENCH JG, BIANKIN SA, LEE CS, MOREY AL, DIJKMAN FP, et al. Pancreatic intraepithelial neoplasia in association with intraductal papillary mucinous neoplasms of the pancreas: implications for disease progression and recurrence. Am J Surg Pathol. 2004;28:1184-92.
2. EGUCHI H, ISHIKAWA H, OHIGASHI T, SASAKI Y, YAMADA T, NAKAIZUMI A, UEHARA H, TAKENAKA A, KASUGAI T, IMAOKA S. Role of intraoperative cytology combined with histology in detecting continuous and skip type intraductal cancer existence for intraductal papillary mucinous carcinoma of the pancreas. Cancer. 2006;107:2567-75.
3. WARSHAW AL, BRUGGE WR, LEWANDROWSKI K. Case 35-2003: a 75-year-old man with a cystic lesion of the pancreas. N Engl J Med. 2003;349:1954-61.
4. MICHAELS PJ, BRACHTEL EF, BOUNDS BC, BRUGGE WR, PITMAN MB et al. Intraductal papillary mucinous neoplasm of the pancreas cytologic features predict histologic grade. Journal American Cancer Society. 2006;108:163-73.
5. LONGNECKER DS, HRUBAN RH, ADLER G, KLOPPEL G. Intraductal papillary-mucinous neoplasms of the pancreas. In: Hamilton SR, Aaltonen LA, editors. World Health Organization classification of tumours. Pathology and genetics of tumours of the digestive System. Lyon: IARC Press; 2000. p. 237-40.
6. KLÖPPEL G, SOLCIA E, LONGNECKER DS, CAPELLA C, SOBIN LH. Histological typing of tumours of the exocrine pancreas. International histological classification of tumours. New York: Springer-Verlag; 1996:15-21.
7. D’ANGELICA M, BRENNAN MF, SURIAWINATA AA, KLIMSTRA D, CONLON KC. Intraductal papillary mucinous neoplasms of the pancreas: an analysis of clinicopathologic features and outcome. Ann Surg. 2004;239:400-8.
8. GALINDO F, KOGAN Z. Tumores quísticos del páncreas. Rev Argent Cir. 1998; 75:140-50.
9. MORAL A, MARGAZO J, MUÑOZ CH, HERNÁNDEZ A, GONZÁLEZ JA et al. Neoplasia papilar intraductal mucinosa del páncreas. Revista Órgano Oficial de la Asociación Española de Cirujanos 2005;77:258-62.
10. FAJARDO R, QUINTERO G. Tumor papilar intraductal mucinoso del páncreas. Rev Colomb Cir. 2002;17:31-6.
11. KIM SY, LEE JM, KIM SH, SHIN KS, KIM YJ, AN SK, et al. Macrocystic neoplasms of the pancreas: CT differentiation of serous oligocystic adenoma from mucinous cystadenoma and intraductal papillary mucinous tumor. AJR. 2006;187:1192-8.
12. FLORES E, FLORES ME, FLORES DM, DELGADO M, et al. Tumores quísticos del páncreas. Archivo Médico de Camagüey. 2007;11(2). Abril 16, 2008; www.amc.sld.cu/amc/2007/v11n2- 2007/2163.htm
13. TANNO S, NAKANO Y, NISHIKAWA T, NAKAMURA K, SASAJIMA J, MINOGUCHI M, et al. Natural history of branch duct intraductal papillary mucinous neoplasms of the pancreas without mural nodules: long term follow-up results. Gut. 2008 Mar; 57(3):339- 43. Epub 2007 Jul 27 Gut. 2008; Mar; 57(3):339-43. Epub 2007, Jul 27.
14. YAMAO K, OHASHI K, NAKAMURA T, SUZUKI T, SHIMIZU Y, NAKAMURA Y, et al. The prognosis of intraductal papillary mucinous tumors of the pancreas. Hepatogastroenterology. 2000;47:1129-34.
15. HOLGUÍN F, LONDOÑO E. Tumor quístico del páncreas. Rev Colomb Cir. 1991;6:87-90.
16. SALVIA R, FERNÁNDEZ-DEL CASTILLO C, BASSI C, THAYER SP, FALCONI M, MANTOVANI W, et al. Main-duct intraductal papillary mucinous neoplasms of the pancreas: clinical predictors of malignancy and long-term survival following resection. Ann Surg. 2004;239:678-85.
17. QUENTIN V, RIOUX-LECLERCQ N, PAGENAULT M, OLIVIÉ D, CAMPION JP, GOSSELIN M, et al. Accuracy of preoperative imaging methods in a retrospective series of 14 patients with operated intraductal papillary mucinous tumors of the pancreas. Gastroenterol Clin Biol. 2005;29:150-5.
18. YEH TS, TSENG JH, CHIU CT, LIU NJ, CHEN TC, JAN YY, et al. Cholangiographic spectrum of intraductal papillarymucinous neoplasm of the bile ducts. Ann Surg. 2006;244:248-53.
19. HARA T, YAMAGUCHI T, ISHIHARA T, TSUYUGUCHI T, KONDO F, KATO K, et al. Diagnosis and patient management of intraductal papillary-mucinous tumor of the pancreas by using peroral pancreatoscopy and intraductal ultrasonography. Gastroenterology. 2002;122:34-43.
20. SOHN TA, YEO CJ, CAMERON JL, HRUBAN RH, FUKUSHIMA N, CAMPBELL KA, et al. Intraductal papillary mucinous neoplasms of the pancreas an updated experience. Ann Surg. 2004;239:788- 99.
21. YAMAGUCHI K, NAKAMURA M, SHIRAHANE K, KAWAMOTO M, KONOMI H, OHTA M, et al. Pancreatic juice cytology in IPMN of the pancreas. Pancreatology. 2005;5:416-21.
22. FALCONI M, SALVIA R, BASSI C, ZAMBONI G, TALAMINI G, PEDERZOLI P. Clinicopathological features and treatment of intraductal papillary mucinous tumour of the pancreas. Br J Surg. 2001;88:376-81.
23. LAU SK, LEWANDROWSKI KB, BRUGGE WR, WARSHAW AL, CENTENO BA. Diagnostic significance of mucin in fine needle aspiration samples of pancreatic cysts. Mod Pathol. 2000;13:48A.
24. CHUNG RS, CHURCH JM, VAN STOLK R. Pancreas-sparing duodenectomy: indications, surgical technique, and results. Surgery. 1995;117:254-9.
25. ISHIKAWA O, OHIGASHI H, NAKAMORI S, SASAKI Y, FURUKAWA H, IMAOKA S, et al. Three-segmental cytodiagnosis using balloon catheter for locating occult carcinoma of the pancreas. J Am Coll Surg. 1995;180:353-5.
26. BASSI C, CRIPPA S, SALVIA R. Intraductal papillary mucinous neoplasms (IPMNs): is it time to (sometimes) spare the knife? Gut. 2008 Mar; 57(3):287-9.
27. EISENBERGER CF, KNOEFEL WT, PEIPER M, YEKEBAS EF, HOSCH SB, BUSCH C, et al. Pancreas-sparing duodenectomy in duodenal pathology: indications and results. Hepatogastroenterology. 2004;51:727-31.
28. CAMERON JL, PITT HA, YEO CJ, LILLEMOE KD, KAUFMAN HS, COLEMAN J. One hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Ann Surg. 1993;217:430-5.
29. CHARI ST, YADAV D, SMYRK TC, DIMAGNO EP, MILLER LJ, RAIMONDO M, et al. Study of recurrence after surgical resection of intraductal papillary mucinous neoplasm of the pancreas. Gastroenterology. 2002;123:1500-7.
30. ADSAY NV, CONLON KC, ZEE SY, BRENNAN MF, KLIMSTRA DS. Intraductal papillary-mucinous neoplasms of the pancreas: an analysis of in situ and invasive carcinomas in 28 patients. Cancer. 2002;94:62-77.
31. LOFTUS EV JR, OLIVARES-PAKZAD BA, BATTS KP, ADKINS MC, STEPHENS DH, SARR MG, BATTS KP, et al. Intraductal papillarymucinous tumors of the pancreas: clinicopathologic features, outcome, and nomenclature. Gastroenterology. 1996;110:1909- 18.
32. COUVELARD A, SAUVANET A, KIANMANESH R, HAMMEL P, COLNOT N, LÉVY P, et al. Frozen sectioning of the pancreatic cut surface during resection of intraductal papillary mucinous neoplasms of the pancreas is useful and reliable: a prospective evaluation. Ann Surg. 2005;242:774-8.
33. BIANKIN AV, KENCH JG, BIANKIN SA, LEE CS, MOREY AL, DIJKMAN FP, et al. Pancreatic intraepithelial neoplasia in association with intraductal papillary mucinous neoplasms of the pancreas: implications for disease progression and recurrence. Am J Surg Pathol. 2004;28:1184-92.
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Publicado
2008-09-20
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López, H.; Moreno, E.; García, M. T.; Álvarez, Íngrid. Neoplasia Papilar Intraductal Mucinosa De páncreas. Rev Colomb Cir 2008, 23, 174-180.
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