Extrapancreatic tumors in intraductal papillary mucinous neoplasm of the pancreas.

Abstract

189 Background: Intraductal papillary mucinous neoplasm (IPMN) of the pancreas has a favorable prognosis, but seems to be associated with a high incidence of extrapancreatic tumors. The purpose of this study was to evaluate the incidence and clinicopathologic features of extrapancreatic tumors associated with IPMN compared with pancreas cancer. Methods: Thirty-seven patients with IPMN of the pancreas and eighty-four patients with pancreas cancer, confirmed by surgical resection and typical findings of endoscopic ultrasonography and CT imaging between October 1, 1998, and August 31, 2009, were included. All pancreas cancers were diagnosed with surgical resection and biopsy. These patients were examined for the development of extrapancreatic tumors. Results: Of 37 patients with IPMN, 14 (38%) had 18 extrapancreatic tumors, and 10 (27%) had 13 extrapancreatic malignancies. Five, six, and two extrapancreatic malignancies had been diagnosed before, during, and after the diagnosis of IPMN. Gastric adenocarcinoma (3 patients, 23%) and colorectal carcinoma (3 patients, 23%) were the most common neoplasms. Other extrapancreatic tumors included lung cancer (n=2), prostatic cancer (n=1), renal cell carcinoma (n=1), cholangiocellular carcinoma (n=1), urinary bladder cancer (n=1), and gallbladder cancer (n=1), respectively. As benign tumor, there were two gallbladder adenoma, one gastric adenoma, one colonic adenoma and one benign ovarian cystic neoplasm, respectively. On the other side, of 84 patients with pancreas cancer, 9 (10%) had 9 extrapancreatic tumors and 2 (2%) had extrapancreatic malignancies which were stomach cancer (n=1, 1%) and breast cancer (n=1, 1%) respectively. As benign tumor, there were colon adenoma (n=3), hepatic hemangioma (n=2), gastric adenoma (n=1), and uterine myoma (n=1). Conclusions: IPMN is associated with high incidence of extrapancreatic tumors, particularly gastric and colorectal neoplasm but pancreas cancer did not show associations with extrapancreatic tumor. Upper gastrointestinal endoscopy and colonoscopy should be done, and systemic surveillance for the possible occurrence of other tumors may allow early detection of extrapancreatic tumor in patients with IPMN. No significant financial relationships to disclose.