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131. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

25.03. - 28.03.2014, Berlin

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Multiple small branch-duct IPMN in imaging in familial pancreatic cancer – Indicator for concomitant high grade pancreatic intraepithelial neoplasia?

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  • Kristin Heeger - Uniklinikum Marburg, Visceral-, Thorax- und Gefäßchirurgie, Marburg
  • Mathias Bargello - Uniklinikum Marburg, Visceral-, Thorax- und Gefäßchirurgie, Marburg
  • Elvira Matthäi - Uniklinikum Marburg, Visceral-, Thorax- und Gefäßchirurgie, Marburg
  • Günter Kloeppel - Uniklinikum Kiel, Pathologie, Kiel
  • Irene Esposito - Technische Universität München, Pathologie, München
  • Johannes Heverhagen - Universitätsspital Bern, Radiologie, Bern
  • Thomas Gress - Uniklinikum Marburg, Gastroenterologie, Marburg
  • Emily Slater - Uniklinikum Marburg, Visceral-, Thorax- und Gefäßchirurgie, Marburg
  • Peter Langer - Klinikum Hanau, Allgemein-, Thorax- und Viszeralchirurgie, Hanau
  • Detlef K. Bartsch - Uniklinikum Marburg, Visceral-, Thorax- und Gefäßchirurgie, Marburg

Deutsche Gesellschaft für Chirurgie. 131. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 25.-28.03.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. Doc14dgch348

doi: 10.3205/14dgch348, urn:nbn:de:0183-14dgch3481

Published: March 21, 2014

© 2014 Heeger et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Introduction: Screening programs for familial pancreatic cancer (FPC) are currently based on endoscopic ultrasonography and / or magnetic resonance imaging. In up to 40% of individuals at risk, cystic lesions are detected, which are suspicious for small intraductal papillary mucinous neoplasms of the branch ducts (BD-IPMN). The pathological importance of these lesions in the setting of FPC is yet unknown.

Material and methods: Individuals at risk from a prospective screening program for familial pancreatic cancer with small "imaging" IPMNs of the branch-duct type (BD-IPMN), who underwent pancreatic resection, were analysed regarding clinico-pathological data and the locations of pancreatic lesions.

Results: In the last 10 years (2002-2012) 172 individuals at risk out of 60 FPC families took part in the screening program. Twelve of these individuals at risk had multiple small (2-10mm) unicystic lesions or multicystic lesions in the pancreatic body and tails suspicious for BD-IPMNs upon MRI imaging. After interdisciplinary counselling, 7 individuals decided to undergo pancreatic resection (6x total pancreatectomy, 1x PPPD), although none fulfilled the consensus criteria for IPMN resection.Histological examination revealed BD-IPMNs with low or moderate dysplasia of the gastric type in combination with multifocal PanIN2 and PanIN3 lesions in 6 individuals. One patient had only tiny ductectasias in the pancreatic tail with multifocal PanIN2 lesions in the entire gland and one PanIN3 lesion in the pancreatic head. Surprisingly, the location of the most dysplastic histological lesions did not correspond to the preoperatively detected lesions and were not visible in preoperative imaging.

Conclusion: In the setting of FPC, the presence of multiple small BD-IPMN in imaging may indicate the presence of high-grade PanIN lesions elsewhere in he pancreas.