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Volume 122, Issue 1, Pages (January 2002)

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1 Volume 122, Issue 1, Pages 34-43 (January 2002)
Diagnosis and patient management of intraductal papillary-mucinous tumor of the pancreas by using peroral pancreatoscopy and intraductal ultrasonography  Taro Hara, Taketo Yamaguchi, Takeshi Ishihara, Toshio Tsuyuguchi, Fukuo Kondo, Kazuki Kato, Takehide Asano, Hiromitsu Saisho  Gastroenterology  Volume 122, Issue 1, Pages (January 2002) DOI: /gast Copyright © 2002 American Gastroenterological Association Terms and Conditions

2 Fig. 1 (A) The height of mucosa or papillary tumor is shown by the arrowheads, and it was measured with a micrometer. (B) The IDUS picture shows papillary tumors of the main pancreatic duct (arrowheads). The height of papillary tumor was measured between the arrowheads. Gastroenterology  , 34-43DOI: ( /gast ) Copyright © 2002 American Gastroenterological Association Terms and Conditions

3 Fig. 2 (A) Height of the lesions by pathology (n = 42). The average height of each lesion correlated well with the grade of malignancy. There was a significant difference between benign and malignant IPMT (P < 0.001). (B) Distribution of protruding lesions by the height as determined by IDUS and by pathological diagnosis (n = 40). The average height of lesions distributed by pathology correlated well with the grade of malignancy. There was a significant difference between benign and malignant IPMT (P < 0.001). Gastroenterology  , 34-43DOI: ( /gast ) Copyright © 2002 American Gastroenterological Association Terms and Conditions

4 Fig. 3 Classification of the protruding lesions by POPS and corresponding pathology. The protruding lesions were classified into 5 groups according to their morphology. (A) Type 1, granular type (H&E staining; original magnification 200×). (B) Type 2, fish-egg–like type without vascular images (H&E staining; original magnification 40×). (C) Type 3, fish-egg–like type with vascular images (H&E staining; original magnification 100×). (D) Type 4, villous type (H&E staining; original magnification 20×). (E) Type 5, vegetative type (H&E staining; original magnification 20×). An intratumoral blood vessel is noted in types 3, 4, and 5. Gastroenterology  , 34-43DOI: ( /gast ) Copyright © 2002 American Gastroenterological Association Terms and Conditions

5 Fig. 4 Distribution of 51 protruding lesions by histopathological diagnosis and POPS type. They showed a high incidence of types 3, 4, and 5 with the pathological diagnosis of CIS or invasive carcinoma. Gastroenterology  , 34-43DOI: ( /gast ) Copyright © 2002 American Gastroenterological Association Terms and Conditions

6 Fig. 5 Main duct type of IPMT (CIS). (A) POPS showing its fish-egg–like appearance with vascular images (type 3). (B) IDUS image showing hyperechoic papillary protruding lesion of the main pancreatic duct (arrow). Gastroenterology  , 34-43DOI: ( /gast ) Copyright © 2002 American Gastroenterological Association Terms and Conditions

7 Fig. 6 Branch duct type of IPMT (invasive carcinoma). (A) POPS showing mild dilatation of main pancreatic duct (MPD) with mucin. (B) IDUS showing a hyperechoic papillary protruding lesion in a cystic dilated branch duct (arrows). Gastroenterology  , 34-43DOI: ( /gast ) Copyright © 2002 American Gastroenterological Association Terms and Conditions

8 Fig. 7 (A) Overall actual survival and disease-free survival in 52 patients followed up after surgery for IPMT. Kaplan-Meier estimates were used. During the mean follow-up of 38 months, there were 4 tumor-related deaths and 1 recurrence. Thus, the overall actual 3-year survival was 95%, and the overall disease-free 3-year survival was 93%. (B) Overall actual survival in 52 patients operated for IPMT calculated for each histopathological type of lesion. There was a significant difference between invasive carcinoma and others (P < 0.05, log-rank test). Upper curve: 5-year survival 100%. Lower curve: 3-year survival 80.4%, 5-year survival 64.6%. Gastroenterology  , 34-43DOI: ( /gast ) Copyright © 2002 American Gastroenterological Association Terms and Conditions


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