Question about IPMT/pancreas

[lemonhead]

Had an EUS the other day and they Dxd me with a IPMT (intraductal papillary mucinous tumor of the pancreas). Please can you tell me some info about this and what would be a good (or typical) course of action?

I also got diagnosed with an unusual polyp in my duondenum which he said needed to come out. How do they remove those?

Thanks.
lemonhead

[Kevin Pho, MD]

Hello - thanks for asking your question.

A type of mucinous tumor of the pancreas has been referred to as mucinous duct ectasia or intraductal papillary mucinous tumor (IPMT). This lesion consists of dilated ductal segments, usually within the head of the pancreas, that are lined by mucous-secreting cells which have high malignant potential. The lesion is more common in men, and may be either localized or diffusely present throughout the pancreas. It should be suspected when thick mucous is seen extruding from the papilla of Vater at the time of endoscopy in a patient with cystic ductal changes in the pancreas. The relationship between IPMT and mucinous cystadenoma/cystadenocarcinoma is not clear. Patients with IPMT can present with repeated episodes of acute pancreatitis, presumably triggered by intermittent duct obstruction caused by mucous plugs.

The incidence of this lesion appears to be increasing. Patients with recurrent pancreatitis caused by IPMT-induced intermittent obstruction should undergo resection of the mucous-secreting abnormal portion of the pancreas. As a general rule, even patients who are asymptomatic should undergo resection because of the significant risk that this lesion may evolve into invasive cancer. Resection may require distal pancreatectomy, pancreaticoduodenectomy, or even total pancreatectomy depending upon the location and extent of the lesion.

I stress that this answer is not intended as and does not substitute for medical advice - please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

Bibliography:
Steer.  Cystic lesions of the pancreas.  UptoDate, 2002.

[surgeon]

treatment of each thing will in part on location, and the nature of the tumors. A duodenal tumor might be removeable by a scope passed into the area from above; if the  problem in the pancreas is in the "head" of the pancreas, and the duodenal tumor is near that area as well, then the operation might be what was referred to above, namely a pancreatico-duodenectomy, meaning removing the head of the pancreas along with the first part of the duodenum, which would remove both problems. It's a pretty big operation, because the intestine needs to be reconnected to the stomach; the bile duct needs reconnection to the intestine, and the pancreas remaining also needs connecting to the intestine. Ideally, such an operation would be done by a surgeon and at a place with lots of experience in that procedure.  The people best able to make specific recommendations and to explain in detail what the options are, are those who know your exact anatomy.  It sounds like you will need lots of input and good explanations based on specifics of your situation. The good news is that both conditions are curable.

[kevinmd]

Welcome to the forum Surgeon.  Nice to see you come over here - it is always nice to have another opinion.

Thanks,
Kevin, M.D.

[lemonhead]

Thank you very much for the info you have both given me. I have an appt with my local GI Doc next week and I will have some dialogue with him as to my options. At least now, I have some idea of what to expect.

Thanks again.
lemonhead

[catwoman2965]

What type of polyp do you have in your duodenum?  I had an adenoma in the papilla of vater (the opening of the bile duct and panceatic duct into the duodenum.  It's the same type normally found in the colon, but mine decided to pop up there, which is kind of unusual.  Mine was beingn, and it was initially removed by ERCP, but then because of where it was, it either grew back or the dr. wasn't able to get all of it the first time.  I had an ERCP initially to remove it, which gave me pancreatitis, and I just had a second one last Friday to remove the remainder of the polyp (which again gave me pancreatitis).  I'm just waiting on the biopsy results.  The ERCP is a type of endoscopic procedure, so it is possible that the polyp in the duodenum can be removed that way.  As everyone else has said, only your dr. can decide what's best for you, but I thought I would share my experience, to give you some idea of what to expect, depending on what your dr. decides to do.

Good luck.

[MichaelB8118]

A related discussion, IPMT was started.