Background: The intraductal papillary-mucinous neoplasms (IPMN) were officially introduced into the TNM Classification in 1996. Based on a two-centre database we set out to reevaluate histopathological findings, clinicopathological clusters, predictive markers for malignancy and outcome.
Methods: Between 1996 and 2006 a total of 1424 pancreatic resections were performed in the University Hospitals Dresden and Mannheim. Pathologists of both institutions reviewed the IPMN-cases and other with cystic or solid tumor diagnoses. All possible markers such as diabetes, jaundice, etc. were analyzed for prediction of malignancy. We performed a survival analysis based upon the morphologic classification to determine the prognosis of IPMN.
Results: There were 43 cases of primarily diagnosed IPMN along with 1174 cases with diagnoses such as ductal adenocarcinoma. In 207 cases the diagnoses revealed other cystic or small solid tumors. A histopathological review of these cases revealed 54 IPMNs, resulting in a total of 97 IPMN-cases (29 non-invasive, 68 invasive). All IPMN-cases had a median survival of 36 months. Recurrence occurred more frequently in invasive IPMN. Predictive markers of malignancy were pain, preoperative weight loss, jaundice and elevated CA 19.9. The strongest independent prognostic factor was invasive growth. The survival analysis revealed excellent prognosis for non-invasive IPMN.
Conclusions: Since the introduction of IPMN in 1996 even specialized centers have had to deal with a learning curve. By re-evaluating all cystic or small solid tumors centres can improve and their patients treatment can be optimized. Since the preoperative diagnostic methods are not sensitive enough to differentiate between benign and malignant lesions surgery is advocated for all IPMN lesions.