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分枝膵管型IPMNの診療アルゴリズム

腫瘍径や壁在結節の有無や画像所見により手術適応を考慮する。
出典
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1: Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas.
著者: Masao Tanaka, Carlos Fernández-Del Castillo, Terumi Kamisawa, Jin Young Jang, Philippe Levy, Takao Ohtsuka, Roberto Salvia, Yasuhiro Shimizu, Minoru Tada, Christopher L Wolfgang
雑誌名: Pancreatology. 2017 Sep - Oct;17(5):738-753. doi: 10.1016/j.pan.2017.07.007. Epub 2017 Jul 13.
Abstract/Text: The management of intraductal papillary mucinous neoplasm (IPMN) continues to evolve. In particular, the indications for resection of branch duct IPMN have changed from early resection to more deliberate observation as proposed by the international consensus guidelines of 2006 and 2012. Another guideline proposed by the American Gastroenterological Association in 2015 restricted indications for surgery more stringently and recommended physicians to stop surveillance if no significant change had occurred in a pancreatic cyst after five years of surveillance, or if a patient underwent resection and a non-malignant IPMN was found. Whether or not it is safe to do so, as well as the method and interval of surveillance, has generated substantial debate. Based on a consensus symposium held during the meeting of the International Association of Pancreatology in Sendai, Japan, in 2016, the working group has revised the guidelines regarding prediction of invasive carcinoma and high-grade dysplasia, surveillance, and postoperative follow-up of IPMN. As the working group did not recognize the need for major revisions of the guidelines, we made only minor revisions and added most recent articles where appropriate. The present guidelines include updated information and recommendations based on our current understanding, and highlight issues that remain controversial or where further research is required.

Copyright © 2017 IAP and EPC. Published by Elsevier B.V. All rights reserved.
Pancreatology. 2017 Sep - Oct;17(5):738-753. doi: 10.1016/j.pan.2017.0...

IPMNの乳頭像

乳頭は開大し、粘液の排出を認める。
出典
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1: 著者提供

主膵管型IPMN(ERCP)

主膵管は著明に拡張し、壁在結節が陰影欠損像として描出されている。
出典
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1: 著者提供

分枝膵管型IPMN(MRCP)

膵頭部と膵尾部にブドウの房状の嚢胞性病変を認めるも、主膵管の拡張は認めない。
出典
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1: 著者提供

MCN(MRCP)

膵体尾部に夏ミカン状の嚢胞性病変を認め、内部に小嚢胞の集簇がみられる(cyst in cyst)。
出典
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1: 著者提供

MCN病理組織像(H.E.染色)

粘液産生性の円柱状の腫瘍細胞に裏打ちされ、腫瘍細胞直下には卵巣様間質( “ovarian-type” stroma, OS)を認める。
出典
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1: 著者提供

主膵管型IPMN

a:CT:体尾部主膵管の著明な拡張を認める
b:ERCP:体尾部主膵管に著明な拡張と尾部主膵管内に壁在結節による陰影欠損像を認める
出典
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1: 著者提供

分枝膵管型IPMN

MRCP:膵頭部と尾部にブドウの房状の分枝膵管の拡張を認めるが主膵管拡張は認めない。
出典
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1: 著者提供

通常型膵癌を合併したIPMN

a:膵体部にブドウの房状の分枝膵管の拡張と主膵管拡張(矢印)を認める。その頭側に主膵管狭窄を認める。
b:ERCP:主膵管拡張の頭側に狭窄像を認める。
出典
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1: 著者提供

MCM

CT(a)、MRCP(b)において、尾部膵に巨大な球形の嚢胞性病変と、嚢胞内に小嚢胞の集簇を認める(cyst in cyst)
出典
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1: 著者提供

分枝膵管型IPMNの診療アルゴリズム

腫瘍径や壁在結節の有無や画像所見により手術適応を考慮する。
出典
imgimg
1: Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas.
著者: Masao Tanaka, Carlos Fernández-Del Castillo, Terumi Kamisawa, Jin Young Jang, Philippe Levy, Takao Ohtsuka, Roberto Salvia, Yasuhiro Shimizu, Minoru Tada, Christopher L Wolfgang
雑誌名: Pancreatology. 2017 Sep - Oct;17(5):738-753. doi: 10.1016/j.pan.2017.07.007. Epub 2017 Jul 13.
Abstract/Text: The management of intraductal papillary mucinous neoplasm (IPMN) continues to evolve. In particular, the indications for resection of branch duct IPMN have changed from early resection to more deliberate observation as proposed by the international consensus guidelines of 2006 and 2012. Another guideline proposed by the American Gastroenterological Association in 2015 restricted indications for surgery more stringently and recommended physicians to stop surveillance if no significant change had occurred in a pancreatic cyst after five years of surveillance, or if a patient underwent resection and a non-malignant IPMN was found. Whether or not it is safe to do so, as well as the method and interval of surveillance, has generated substantial debate. Based on a consensus symposium held during the meeting of the International Association of Pancreatology in Sendai, Japan, in 2016, the working group has revised the guidelines regarding prediction of invasive carcinoma and high-grade dysplasia, surveillance, and postoperative follow-up of IPMN. As the working group did not recognize the need for major revisions of the guidelines, we made only minor revisions and added most recent articles where appropriate. The present guidelines include updated information and recommendations based on our current understanding, and highlight issues that remain controversial or where further research is required.

Copyright © 2017 IAP and EPC. Published by Elsevier B.V. All rights reserved.
Pancreatology. 2017 Sep - Oct;17(5):738-753. doi: 10.1016/j.pan.2017.0...

IPMNの乳頭像

乳頭は開大し、粘液の排出を認める。
出典
img
1: 著者提供