Focal Pancreatic Parenchymal Atrophy in Main Duct Intraductal Papillary Mucinous Neoplasms of the Pancreas

TL;DR

The study found that focal pancreatic atrophy is present in about 20% of pancreatic tumors called MD-IPMNs, and these tumors may represent an early stage of the disease.

Contribution

This study is the first to clarify the relationship between focal pancreatic atrophy and MD-IPMNs, suggesting a biologically distinct subset.

Findings

Focal pancreatic parenchymal atrophy (FPPA) was observed in 21% of MD-IPMN patients.

MD-IPMNs in FPPA patients had a significantly smaller main pancreatic duct diameter compared to those with upstream atrophy.

In 75% of FPPA cases, the tumor was histologically contained within the atrophic area.

Abstract

Introduction

Although upstream pancreatic atrophy (UPA) is a characteristic finding in main duct intraductal papillary mucinous neoplasms (MD-IPMNs) of the pancreas, the relationship between MD-IPMNs and focal pancreatic parenchymal atrophy (FPPA), which is an indicator of early-stage pancreatic ductal adenocarcinoma, remains unclear. Thus, this study aimed to investigate the relationship.

Methods

From the 49 patients diagnosed with MD-IPMNs using the resected specimens from June 2003 to December 2023, 19 patients were selected to clarify the clinical characteristics of FPPA for MD-IPMN patients. The primary outcome measure was the frequency of FPPA/UPA. Secondary outcome measures were (1) the locational relationship between MD-IPMN and FPPA and (2) the clinicopathological differences between those atrophic types.

Results

FPPA and UPA were observed in 4 (21%) and 12 (63%) patients, respectively. When the clinicopathological factors of FPPA and UPA patients were compared, only the diameter of the main pancreatic duct (MPD) significantly differed (median MPD diameter: 6 mm vs. 11 mm, p = 0.017). Of the four patients with FPPA, the histological extent of the MD-IPMN lesion was within that of FPPA in three patients (75%) and was concordant with that of FPPA only in one patient (25%).

Conclusions

FPPAs were detected in approximately 20% of resected MD-IPMNs, and 75% of those MD-IPMNs were histologically included in the area of the FPPAs. Since the MPD diameter was significantly smaller for MD-IPMNs with FPPAs than those with UPAs, MD-IPMNs with FPPAs may be biologically related to the mild dilation of the MPD, such as lesions at an early stage or less mucin secretion.

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