Intraductal papillary mucinous neoplasm of the pancreas: an emerging indication for surgical therapy.

differential diagnosis a need when cystic profile lesions are found in the pancreas (1,2). And of course intraductal papillary mucinous neoplasm of the pancreas must be carefully assessed in the differential diagnosis of such lesions. For every finding that is cystic in nature a first step is always to tell tumors, whether benign or malignant, from non-neoplastic conditions. To consider a cystic lesion neoplastic, the presence of an epithelial tissue band separating normal pancreatic tissue from the cyst must be identified. In addition to pseudocyst, non-neoplastic cystic lesions of the pancreas include simple pancreatic cyst, a concept that remains poorly delimited. For some authors these non-neoplastic cysts would include retention cysts as well as mucoceles. However, other authors consider that smaller unilocular cysts with thin walls may similarly represent papillary tumors with low-grade dysplasia rather than the more concerning condition of intraductal papillary mucinous tumor with malignant changes. Among neoplastic pancreatic cysts serous cystic tumors (cystadenoma and cystadenocarcinoma), mucinous cystic tumors (cystadenoma, cystadenoma with dysplasia, and mucinous cystadenocarcinoma), and intraductal papillary mucinous tumors (adenoma, tumor with dysplasia, and intraductal papillary mucinous carcinoma) should be considered, the latter being the subject of this editorial. Serous cystic tumors most commonly involve the head of the pancreas and are typically multilocular with septa in their inside. Benign unilocular cystadenomas may on occasion exist that are preoperatively indistinguishable from unilocular mucinous cystic tumors. Mucinous cystic tumors most commonly involve the body and tail of the pancreas, may be unilocular or multilocular, and typically affect women. They should be formally considered a lesion with a potential to progress from benignity to malignity. Multilocular tumors are easier to diagnose since walls are usually obvious and calcification may be present. However, unilocular lesions have a more challenging differential diagnosis. On occasion other non-cystic lesions such as pseudopapillary or endocrine tumors may undergo tissue necrosis resulting in a cyst, and thus should also be included in the differential diagnosis. Intraductal papillary mucinous tumors originate in the tissue of pancreatic ducts, whether the main duct or any of its branches. Therefore, their diagnosis becomes more likely when the cystic tumor can be seen to communicate with pancreatic ducts at any level. These tumors are incidental findings in up to one third of cases. Echoendoscopy increases diagnostic certainty in this type of neoplasm as in expert hands will allow a refined definition of lesion features and a guided puncture to Intraductal papillary mucinous neoplasm of the pancreas: an emerging indication for surgical therapy 1130-0108/2010/102/5/293-295 REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS Copyright © 2010 ARÁN EDICIONES, S. L. REV ESP ENFERM DIG (Madrid) Vol. 102, N.° 5, pp. 293-295, 2010