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Intraductal papillary mucinous neoplasm of the pancreas: Cytomorphology, imaging, molecular profile, and prognosis
Author(s) -
Geramizadeh Bita,
Marzban Mahsa,
Shojazadeh Alireza,
Kadivar Ana,
Maleki Zahra
Publication year - 2021
Publication title -
cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.512
H-Index - 48
eISSN - 1365-2303
pISSN - 0956-5507
DOI - 10.1111/cyt.12973
Subject(s) - medicine , intraductal papillary mucinous neoplasm , dysplasia , pathology , pancreas , malignancy , atypia , pancreatic intraepithelial neoplasia , nuclear atypia , pancreatic duct , pancreatic cancer , cancer , pancreatic ductal adenocarcinoma , immunohistochemistry
Background Intraductal papillary mucinous neoplasm (IPMN) constitutes up to 20% of all pancreatic resections, and has been increasing in recent years. Histomorphological findings of IPMN are well established; however, there are not many published papers regarding the cytological findings of IPMN on fine needle aspiration (FNA) specimens. We review the cytomorphological features, molecular profile, imaging findings, and prognosis of IPMN. Methods The English literature was thoroughly searched with key phrases containing IPMN. Observations IPMN is a rare entity, affecting men and women equally and is usually diagnosed at the age of 60‐70 years. The characteristic imaging features include a cystic lesion with associated dilatation of the main or branch pancreatic duct, and atrophy of surrounding pancreatic parenchyma. Cytomorphological features of IPMN include papillary fragments of mucinous epithelium in a background of abundant thick extracellular mucin, a hallmark feature. IPMNs should be evaluated for high‐grade dysplasia, which manifests with nuclear atypia, nuclear moulding, prominent nucleoli, nuclear irregularity, and cellular crowding. Molecular profiling of IPMN along with carcinoembryonic antigen and amylase levels is useful in predicting malignancy or high‐grade dysplasia arising in IPMN. Overall, the prognosis of IPMN is excellent except in those cases with high‐grade dysplasia and malignant transformation. Postoperative surveillance is required for resected IPMNs. Conclusion IPMN requires a multidisciplinary approach for management. Cytomorphological findings of IPMN on FNA, in conjunction with tumour markers in pancreatic fluid cytology and imaging findings, are of paramount importance in clinical decision‐making for IPMN.