Intraductal papillary mucinous neoplasms of the pancreas: Diagnosis and management

European Journal of Gastroenterology and Hepatology

Volumn 22, Issue 9, 2010, Pages 1029-1038

  Liu, Dongbin ^a,b   Li, Fei ^a   Josefin, Björk Werner ^a   Roland, Andersson ^a  

^a LUND UNIVERSITY   (Sweden)

^b CAPITAL MEDICAL UNIVERSITY   (China)

Author keywords

diagnostic methods; intraducal papillary mucinous neoplasms; pancreatic tumor; surgery

Indexed keywords

ASPIRATION BIOPSY; ASPIRATION CYTOLOGY; CANCER CLASSIFICATION; CANCER DIAGNOSIS; CANCER PATIENT; CANCER RECURRENCE; CANCER SURGERY; ENDOCRINE FUNCTION; ENDOSCOPIC ECHOGRAPHY; FOLLOW UP; HUMAN; INTRADUCTAL PAPILLARY MUCINOUS TUMOR; PANCREAS FUNCTION; PANCREAS JUICE; PANCREAS RESECTION; PANCREAS TUMOR; POSITRON EMISSION TOMOGRAPHY; PREOPERATIVE EVALUATION; PRIORITY JOURNAL; REVIEW;

ADENOCARCINOMA, MUCINOUS; CARCINOMA, PANCREATIC DUCTAL; HUMANS; PANCREATIC NEOPLASMS;

EID: 77955469347     PISSN: 0954691X     EISSN: None     Source Type: Journal    
DOI: 10.1097/MEG.0b013e32833b00f9     Document Type: Review

References (95)

1. Ohhashi K, Murakami Y, Maruyama M, Taketoshi T, Ohta T, Ohhashi I, et al. Four cases of mucous secreting pancreatic cancer. Prog Dig Endosc 1982; 20:348-351.
2. Klöppel G, Solcia E, Longnecker DS, Capella C, Sobin LH. Histological typing of tumors of the exocrine pancreas. In: Klöppel G, Solcia E, Longnecker DS, Capella C, Sobin LH, editors. World Health Organization International Classification of Tumors. 2nd ed. Berlin: Springer; 1996. pp. 11-22.
3. Longnecker DS, Adler G, Hruban RH, Klöppel G. Intraductal papillarymucinous neoplasms of the pancreas. In: Hamilton SR, Aaltonen LA, editors. World Health Organization classification of tumors. Pathology and genetics of tumors of the digestive system. Lyon: IARC Press; 2000. pp. 237-240.
4. Katabi N, Klimstra DS. Intraductal papillary mucinous neoplasms of the pancreas: clinical and pathological features and diagnostic approach. J Clin Pathol 2008; 61:1303-1313.
5. Hruban RH, Takaori K, Klimstra DS, Adsay NV, Albores-Saavedra J, Biankin AV, et al. An illustrated consensus on the classification of pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasms. Am J Surg Pathol 2004; 28:977-987.
6. Reddy R, Chari ST. IPMN: not a new kid on the block anymore. Gastroenterology 2004; 127:1853-1855.
7. Katz MH, Mortenson MM, Wang H, Hwang R, Tamm EP, Staerkel G, et al. Diagnosis and management of cystic neoplasms of the pancreas: an evidence-based approach. J Am Coll Surg 2008; 207:106-120.
8. Cameron JL, Riall TS, Coleman J, Belcher KA. One thousand consecutive pancreaticoduodenectomies. Ann Surg 2006; 244:10-15.
9. Reid-Lombardo KM, St Sauver J, Li Z, Ahrens WA, Unni KK, Que FG, et al. Incidence, prevalence, and management of intraductal papillary mucinous neoplasm in Olmsted County, Minnesota, 1984-2005 -a population study. Pancreas 2008; 37:139-144.
10. Salvia R, Fernandez-del Castillo C, Bassi C, Thayer SP, Falconi M, Mantovani W, et al. Main-duct intraductal papillary mucinous neoplasms of the pancreas: clinical predictors of malignancy and long-term survival following resection. Ann Surg 2004; 239:678-685. discussion 685-687.
11. Sauvanet A. Intraductal papillary mucinous neoplasms of the pancreas: indication, extent, and results of surgery. Surg Oncol Clin N Am 2008; 17:587-606.
12. Gourgiotis S, Ridolfini MP, Germanos S. Intraductal papillary mucinous neoplasms of the pancreas. Eur J Surg Oncol 2007; 33:678-684.
13. Yamaguchi K, Ogawa Y, Chijiiwa K, Tanaka M. Mucin-hypersecreting tumors of the pancreas: assessing the grade of malignancy preoperatively. Am J Surg 1996; 171:427-431.
14. Bassi C, Sarr MG, Lillemoe KD, Reber HA. Natural history of intraductal papillary mucinous neoplasms (IPMN): current evidence and implications for management. J Gastrointest Surg 2008; 12:645-650.
15. D'Angelica M, Brennan MF, Suriawinata AA, Klimstra D, Conlon KC. Intraductal papillary mucinous neoplasms of the pancreas: an analysis of clinicopathologic features and outcome. Ann Surg 2004; 239:400-408.
16. Falconi M, Salvia R, Bassi C, Zamboni G, Talamini G, Pederzoli P. Clinicopathological features and treatment of intraductal papillary mucinous tumor of the pancreas. Br J Surg 2001; 88:376-381.
17. Bernard P, Scoazec JY, Joubert M, Kahn X, Le Borgne J, Berger F, et al. Intraductal papillary-mucinous tumors of the pancreas: predictive criteria of malignancy according to pathological examination of 53 cases. Arch Surg 2002; 137:1274-1278.
18. Tanaka M, Chari S, Adsay V, Fernandez-del Castillo C, Falconi M, Shimizu M, et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 2006; 6:17-32.
19. Sohn TA, Yeo CJ, Cameron JL, Hruban RH, Fukushima N, Campbell KA, et al. Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Ann Surg 2004; 239:788-799.
20. Adsay NV, Merati K, Basturk O, Iacobuzio-Donahue C, Levi E, Cheng JD, et al. Pathologically and biologically distinct types of epithelium in intraductal papillary mucinous neoplasms. Delineation of an Intestinal pathway of carcinogenesis in the pancreas. Am J Surg Pathol 2004; 28:839-848.
21. Sakorafas GH, Sarr MG, van de Velde CJ, Peros G. Intraductal papillary mucinous neoplasms of the pancreas: a surgical perspective. Surg Oncol 2005; 14:155-178.
22. Honda K, Kume K, Yamasaki M, Yoshikawa I, Otsuki M. Pancreatico-gastric fistulas due to intraductal papillary mucinous neoplasm. Inter Med 2008; 47:557-558.
23. Su GH, Hruban RH, Bansal RK, Bova GS, Tang DJ, Shekher MC, et al. Germline and somatic mutations of the STK11/LKB1 Peutz-Jeghers gene in pancreatic and biliary cancers. Am J Pathol 1999; 154:1835-1840.
24. Madura JA, Schmidt CM, Yum MN. Mucin secreting cystic lesions of the pancreas: treatment by enucleation. Am Surg 2004; 70:106-112.
25. Burdick JS. Intraductal papillary mucinous neoplasms. Gastrointest Endosc Clin N Am 2008; 18:523-533.
26. Baba T, Yamaguchi T, Ishihara T, Kobayashi A, Oshima T, Sakaue N, et al. Distinguishing benign from malignant intraductal papillary mucinous tumors of the pancreas by imaging techniques. Pancreas 2004; 29:212-217.
27. Kawamoto S, Horton KM, Lawler LP, Hruban RH, Fishman EK. Intraductal papillary mucinous neoplasm of the pancreas: can benign lesions be differentiated from malignant lesions with multidetector CT? Radiographics 2005; 25:1451-1468. discussion 1468-147.
28. Kawamoto S, Lawler LP, Horton KM, Eng J, Hruban RH, Fishman EK. MDCT of intraductal papillary mucinous neoplasm of the pancreas: evaluation of features predictive of invasive carcinoma. Am J Roentgenol 2006; 186:687-695.
29. Taouli B, Vilgrain V, Vullierme MP, Terris B, Denys A, Sauvanet A, et al. Intraductal papillary mucinous tumors of the pancreas: helical CT with histopathologic correlation. Radiology 2000; 217:757-764.
30. Fukukura Y, Fujiyoshi F, Sasaki M, Inoue H, Yonezawa S, Nakajo M. Intraductal papillary mucinous tumors of the pancreas: thin-section helical CT findings. Am J Roentgenol 2000; 174:441-447.
31. Gupta R, Mortelé KJ, Tatli S, Girshman J, Glickman JN, Levy AD, et al. Pancreatic intraductal papillary mucinous neoplasms: role of CT in predicting pathologic subtypes. Am J Roentgenol 2008; 191:1458-1464.
32. Ogawa H, Itoh S, Ikeda M, Suzuki K, Naganawa S. Intraductal papillary mucinous neoplasm of the pancreas: assessment of the likelihood of invasiveness with multisection CT. Radiology 2008; 248:876-886.
33. Megibow AJ, Lavelle MT, Rofsky NM. Cystic tumors of the pancreas. The radiologist. Surg Clin North Am 2001; 81:489-495.
34. Waters JA, Schmidt CM, Pinchot JW, White PB, Cummings OW, Pitt HA, et al. CT vs. MRCP: optimal classification of IPMN type and extent. J Gastrointest Surg 2008; 12:101-109.
35. Shima Y, Mori M, Takakura N, Kimura T, Yagi T, Tanaka N. Diagnosis and management of cystic pancreatic tumor with mucin production. Br J Surg 2000; 87:1041-1047.
36. Aithal G, Chen R, Cunningham J, Durkalski V, Kim EY, Patel RS, et al. Accuracy of EUS for detection of intraductal papillary mucinous tumor of the pancreas. Gastrointest Endosc 2002; 56:701-707.
37. Ahmad N, Kochman M, Brensinger C, Brugge WR, Faigel DO, Gress FG, et al. Intraobserver agreement among endosonographers for the diagnosis of neoplastic vs. nonneoplastic pancreatic cystic lesions. Gastrointest Endosc 2003; 58:59-64.
38. Ahmad NA, Kochman ML, Lewis JD, Ginsberg GG. Can EUS alone differentiate between malignant and benign cystic lesions of the pancreas? Am J Gastroenterol 2001; 96:3295-3300.
39. Brugge WR, Lewandrowski K, Lee-Lewandrowski E, Centeno BA, Szydlo T, Regan S, et al. Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology 2004; 126:1330-1336.
40. Yamao K, Okubo K, Sawaka A, Hara K, Nakamura T, Suzuki T, et al. Endoluminal ultrasonography in the diagnosis of pancreatic diseases. Abdom Imaging 2003; 28:545-555.
41. Hara T, Yamaguchi T, Ishihara T, Tsuyuguchi T, Kondo F, Kato K, et al. Diagnosis and patient management of intraductal papillary mucinous tumor of the pancreas by using peroral pancreatoscopy and intraductal ultrasonography. Gastroenterology 2002; 122:34-43.
42. Prassopoulos P, Raptopoulos V, Chuttani R, McKee JD, McNicholas MM, Sheiman RG. Development of virtual CT cholangiopancreatoscopy. Radiology 1998; 209:570-574.
43. Nakagohri T, Jolesz FA, Okuda S, Asano T, Kenmochi T, Kainuma O, et al. Virtual pancreatoscopy of mucin-producing pancreatic tumors. Comput Aid Surg 1998; 3:264-268.
44. Sata N, Kurihara K, Koizumi M, Tsukahara M, Yoshizawa K, Nagai H. CT virtual pancreatoscopy: a new method for diagnosing intraductal papillary mucinous neoplasm (IPMN) of the pancreas. Abdom Imaging 2006; 31:326-331.
45. Recine M, Kaw M, Evans DB, Krishanamurthy S. Fine-needle aspiration cytology of mucinous tumors of the pancreas. Cancer 2004; 102:92-99.
46. Mallery JS, Centeno BA, Hahn PF, Chang Y, Warshaw AL, Brugge WR. Pancreatic tissue sampling guided by EUS, CT/US, and surgery: a comparison of sensitivity and specificity. Gastrointest Endosc 2002; 56:218-224.
47. Voss M, Hammel P, Molas G, Palazzo L, Dancour A, O'Toole D, et al. Value of endoscopic ultrasound guided fine needle aspiration biopsy in the diagnosis of solid pancreatic masses. Gut 2000; 46:244-249.
48. Attasaranya S, Pais S, LeBlanc J, McHenry L, Sherman S, DeWitt JM. Endoscopic ultrasound-guided fine needle aspiration and cyst fluid analysis for pancreatic cysts. JOP 2007; 8:553-563.
49. Maire F, Couvelard A, Hammel P, Ponsot P, Palazzo L, Aubert A, et al. Intraductal papillary mucinous tumors of the pancreas: the preoperative value of cytologic and histopathologic diagnosis. Gastrointest Endosc 2003; 58:701-706.
50. Schmidt CM, White PB, Waters JA, Yiannoutsos CT, Cummings OW, Baker M, et al. Intraductal papillary mucinous neoplasms: predictors of malignant and invasive pathology. Ann Surg 2007; 246:644-651. discussion 651-654.
51. Stelow EB, Stanley MW, Bardales RH, Mallery S, Lai R, Linzie BM, et al. Intraductal papillary-mucinous neoplasm of the pancreas. The findings and limitations of cytologic samples obtained by endoscopic ultrasound-guided fine needle aspiration. Am J Clin Pathol 2003; 120:398-404.
52. Yamao K. Complications of endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNAB) for pancreatic lesions. J Gastroenterol 2005; 40:921-923.
53. Z'graggen K, Rivera JA, Compton CC, Pins M, Werner J, Fernández-del Castillo C, et al. Prevalence of activating K-ras mutations in the evolutionary stages of neoplasia in intraductal papillary mucinous tumors of the pancreas. Ann Surg 1997; 226:491-500.
54. Iwao T, Tsuchida A, Hanada K, Eguchi N, Kajiyama G, Shimamoto F. Immunocytochemical detection of p53 protein as an adjunct in cytologic diagnosis from pancreatic duct brushings in mucinproducing tumors of the pancreas. Cancer 1997; 81:163-171.
55. Inoue H, Tsuchida A, Kawasaki Y, Fujimoto Y, Yamasaki S, Kajiyama G. Preoperative diagnosis of intraductal papillarymucinous tumors of the pancreas with attention to telomerase activity. Cancer 2001; 91:35-41.
56. Sahani DV, Lin DJ, Venkatesan AM, Sainani N, Mino-Kenudson M, Brugge WR, et al. Multidisciplinary approach to diagnosis and management of intraductal papillary mucinous neoplasms of the pancreas. Clin Gastroenterol Hepatol 2009; 7:259-269.
57. Maire F, Voitot H, Aubert A, Palazzo L, Palazzo L, O'Toole D, Couvelard A, Intraductal papillary mucinous neoplasms of the pancreas: performance of pancreatic fluid analysis for positive diagnosis and the prediction of malignancy. Am J Gastroenterol 2008; 103:2871-2877.
58. Pais SA, Attasaranya S, Leblanc JK, Sherman S, Schmidt CM, DeWitt J. Role of endoscopic ultrasound in the diagnosis of intraductal papillary mucinous neoplasms: correlation with surgical histopathology. Clin Gastroenterol Hepatol 2007; 5:489-495.
59. Ito H, Endo T, Oka T, Matumoto T, Abe T, Toyota M, et al. Mucin expression profile is related to biological and clinical characteristics of intraductal papillary-mucinous tumors of the pancreas. Pancreas 2005; 30:96-102.
60. Sawai H, Okada Y, Funahashi H, Matsuo Y, Tanaka M, Manabe T. Immunohistochemical analysis of molecular biological factors in intraductal papillary-mucinous tumors and mucinous cystic tumors of the pancreas. Scand J Gastroenterol 2004; 39:1159-1165.
61. Luttges J, Feyerabend B, Buchelt T, Pacena M, Kloppel G. The mucin profile of noninvasive and invasive mucinous cystic neoplasms of the pancreas. Am J Surg Pathol 2002; 26:466-471.
62. Sperti C, Bissoli S, Pasquali C, Frison L, Liessi G, Chierichetti F, et al. 18-fluorodeoxyglucose positron emission tomography enhances computed tomography diagnosis of malignant intraductal papillary mucinous neoplasms of the pancreas. Ann Surg 2007; 246:932-937. discussion 937-939.
63. Baiocchi GL, Portolani N, Bertagna F, Gheza F, Pizzocaro C, Giubbini R, et al. Possible additional value of 18FDG-PET in managing pancreas intraductal papillary mucinous neoplasms: preliminary results. J Exp Clin Cancer Res 2008; 27:10.
64. Nagai K, Doi R, Kida A, Kami K, Kawaguchi Y, Ito T, et al. Intraductal papillary mucious neoplasms of pancreas: cliniclpathologic characteristics and longterm follow-up after resection. World J Surg 2008; 32:271-278. discussion 279-280.
65. Terris B, Ponsot P, Paye F, Hammel P, Sauvanet A, Molas G, et al. Intraductal papillary mucinous tumors of the pancreas confined to secondary ducts show less aggressive pathologic features as compared with those involving the main pancreatic duct. Am J Surg Pathol 2000; 24:1372-1377.
66. Imaizumi T, Hatori T, Harada N, Fukuda A, Takasaki K, Hanyu F. Intraductal papillary mucinous neoplasm of the pancreas; resection and cancer prevention. Am J Surg 2007; 194:s5-s9.
67. Vullierme MP, Giraud-Cohen M, Hammel P, Sauvanet A, Couvelard A, O'Toole D, et al. Malignant intraductal papillary mucinous neoplasm of the pancreas: in situ vs. invasive carcinoma surgical resectability. Radiology 2007; 245:483-490.
68. Kimura W, Sasahira N, Yoshikawa T, Muto T, Makuuchi M. Duct-ectatic type of mucin producing tumor of the pancreas: new concept of pancreatic neoplasia. Hepatogastroenterology 1996; 43:692-709.
69. Sohn TA, Yeo CJ, Cameron JL, Iacobuzio-Donahue CA, Hruban RH, Lillemoe KD. Intraductal papillary mucinous neoplasms of the pancreas: an increasingly recognized clinicopathologic entity. Ann Surg 2001; 234:313-321. discussion 321-322.
70. Tanaka M. Intraductal papillary mucinous neoplasm of the pancreas: diagnosis and treatment. Pancreas 2004; 28:282-288.
71. Irie H, Yoshimitsu K, Aibe H, Tajima T, Nishie A, Nakayama T, et al. Natural history of pancreatic intraductal papillary mucinous tumor of branch duct type: follow-up study by magnetic resonance cholangiopancreatography. J Comput Assist Tomogr 2004; 28:117-122.
72. Paik KY, Choi SH. Experience of limited pancreatic head resection for management of branch duct intraductal papillary mucinous neoplasm in a single center. World J Gastroenterol 2009; 15:2904-2907.
73. Kaneko T, Nakao A, Inoue S, Sugimoto H, Hatsuno T, Ito A, et al. Intraoperative ultrasonography by high-resolution annular array transducer for intraductal papillary mucinous tumors of the pancreas. Surgery 2001; 129:55-65.
74. Paye F, Sauvanet A, Terris B, Ponsot P, Vilgrain V, Hammel P, et al. Intraductal papillary mucious tumors of pancreas: pancreatic resections guided by preoperative morphological assessment and intraoperative frozen section examination. Surgery 2000; 127:536-544.
75. Gigot JF, Deprez P, Sempoux C, Descamps C, Metairie S, Glineur D, et al. Surgical management of intraductal papillary mucinous tumors of the pancreas: the role of routine frozen section of the surgical margin, intra-operative endoscopic staged biopsies of the Wirsung duct, and pancreaticogastric anastomosis. Arch Surg 2001; 136:1256-1262.
76. Crippa S, Bassi C, Warshaw AL, Falconi M, Partelli S, Thayer SP, et al. Middle pancreatectomy: indications, short- and long-term operative outcomes. Ann Surg 2007; 246:69-76.
77. Kanazumi N, Nakao A, Kaneko T, Takeda S, Harada A, Inoue S, et al. Surgical treatment of intraductal papillary-mucinous tumors of the pancreas. Hepatogastroenterology 2001; 48:967-971.
78. Nakao A, Fernández-Cruz L. Pancreatic head resection with segmental duodenectomy: safety and long-term results. Ann Surg 2007; 246:923-928. discussion 929-931.
79. Thayer SP, Ferná ndez-del Castillo C, Balcom JH, Warshaw AL. Complete dorsal pancreatectomy with preservation of the ventral pancreas: a new surgical technique. Surgery 2002; 131:577-580.
80. Lukish JR, Rothstein JH, Petruzziello M, Kiteley R, Denobile J, Soballe P. Spleen-preserving pancreatectomy for cystic pancreatic neoplasms. Am Surg 1999; 65:596-599.
81. Niedergethmann M, Grützmann R, Hildenbrand R, Dittert D, Aramin N, Franz M, et al. Outcome of invasive and noninvasive intraductal papillarymucinous neoplasms of the pancreas (IPMN): a 10-year experience. World J Surg 2008; 32:2253-2260.
82. White R, D'Angelica M, Katabi N, Tang L, Klimstra D, Fong Y, et al. Fate of the remnant pancreas after resection of noninvasive intraductal papillary mucinous neoplasm. J Am Coll Surg 2007; 204:987-993. discussion 993-995.
83. Couvelard A, Sauvanet A, Kianmanesh R, Hammel P, Colnot N, Lé vy P, et al. Frozen sectioning of the pancreatic cut surface during resection of intraductal papillary mucinous neoplasms of the pancreas is useful and reliable: a prospective evaluation. Ann Surg 2005; 242:774-778. discussion 778-780.
84. Farnell MB. Surgical management of intraductal papillary mucinous neoplasm (IPMN) of the pancreas. J Gastrointest Surg 2008; 12:414-416.
85. Raut CP, Cleary KR, Staerkel GA, Abbruzzese JL, Wolff RA, Lee JH, et al. Intraductal papillary mucinous neoplasms of the pancreas: effect of invasion and pancreatic margin status on recurrence and survival. Ann Surg Oncol 2006; 13:582-594.
86. Chari ST, Yadav D, Smyrk TC, DiMagno EP, Miller LJ, Raimondo M, et al. Study of recurrence after surgical resection of intraductal papillary mucinous neoplasm of the pancreas. Gastroenterology 2002; 123:1500-1507.
87. Tajiri T, Tate G, Inagaki T, Kunimura T, Inoue K, Mitsuya T, et al. Intraductal tubular neoplasms of the pancreas: histogenesis and differentiation. Pancreas 2005; 30:115-121.
88. Cuillerier E, Cellier C, Palazzo L, Devié re J, Wind P, Rickaert F, et al. Outcome after surgical resection of intraductal papillary and mucinous tumors of the pancreas. Am J Gastroenterol 2000; 95:441-445.
89. Richter A, Niedergethmann M, Sturm JW, Lorenz D, Post S, Trede M. Long-term results of partial pancreaticoduodenectomy for ductal adenocarcinoma of the pancreatic head: 25-year experience. World J Surg 2003; 27:324-329.
90. Salvia R, Crippa S, Falconi M, Bassi C, Guarise A, Scarpa A, et al. Branchduct intraductal papillary mucinous neoplasms of the pancreas: to operate or not to operate? Gut 2007; 56:1086-1090.
91. Ishida M, Egawa S, Kawaguchi K, Aoki T, Sakata N, Mikami Y, et al. Synchronous and metachronous extrapancreatic malignant neoplasms in patients with intraductal papillary-mucinous neoplasm of the pancreas. Pancreatology 2008; 8:577-582.
92. Eguchi H, Ishikawa O, Ohigashi H, Tomimaru Y, Sasaki Y, Yamada T, et al. Patients with pancreatic intraductal papillary mucinous neoplasms are at high risk of colorectal cancer development. Surgery 2006; 139:749-754.
93. Kamisawa T, Tu Y, Egawa N, Nakajima H, Tsuruta K, Okamoto A. Malignancies associated with intraductal papillary mucinous neoplasm of the pancreas. World J Gastroenterol 2005; 11:5688-5690.
94. Christensen JA, Fletcher JG, Fidler JL, Wold PB, Binstock AJ, Smyrk T, et al. Intraductal papillary mucinous neoplasms of the pancreas: CT patterns of recurrence and multiobserver performance in detecting recurrent neoplasm after surgical resection. Am J Roentgenol 2004; 183:1367-1374.
95. Raimondo M, Tachibana I, Urrutia R, Burgart LJ, DiMagno EP. Invasive cancer and survival of intraductal papillary mucinous tumors of the pancreas. Am J Gastroenterol 2002; 97:2553-2558.