GASTROENTEROLOGY ARTICLE OF THE WEEK
January 20, 2011
Fernandez-del Castillo C, Adsay NV. Intraductal papillary mucinous neoplasms of the pancreas. Gastroenterology 2010;139:708-713.
1. Compared to side branched IPMN, mucinous cysts of the pancreas
a. contain an ovarian-like stroma
b. Are usually multiple
c. Usually located in the head
d. Are more common in middle age females
2. Observation is recommended for
a. BD-IPMN with cysts of 0.5 to 1cm, CEA of 800
b. Main duct IPMN disease in a 50 year old healthy man
c. Main duct IPMN with intestinal type epithelium in a symptomatic 65 year old
man with hypertension
d. BD-IPMN, 2cm at diagnosis, 5cm 1 year later
3. After a diagnosis of BD-IPMN and decision not to resect, repeat imaging should be done at
a. 2 years
b. 6 months
c. 3 months
d. 1 year
True or False
4. The test of choice to evaluate branch IPMN is ERCP
5. The risk of malignancy with BD-IPMN is 25%, compared to 70% for main duct IPMN
6. Main duct IPMN usually has intestinal type epithelium, at higher risk for malignancy
7. The level of CEA in the mucin correlates with risk of malignancy from IPMN
8. Side branched IPMN usually presents radiologically as a cyst or cluster of cysts, frequently in the uncinate process, without main pancreatic duct dilation
9. IPMN in the US affects primarily men in their 60’s.
10. Current recommendations are to recommend surgical removal for patients with an adequate surgical risk and the presence of main duct IPMN
11. Pancreatitis as a presenting symptom of IPMN is seeing only with main-branch IPMN
12. Most BD-IPMN have gastric-type epithelium with a low risk of malignancy