John R. Gaughen, Jr., M.D.

January 12, 2006


Intraductal papillary mucinous tumor (IPMT) is an uncommon intraductal epithelial pancreatic tumor that is associated with extensive mucinous secretion. This lesion most commonly affects middle-aged adults, with no sex predilection. This lesion is divided into two subcategories, main duct and branch duct IPMT, both presenting clinically with abdominal pain or symptoms of acute or recurrent pancreatitis. Although often visible on abdominal CT, IPMT is most clearly delineated with MRI, MRCP, and ERCP. Main duct IPMN often shows diffuse main and cystic branch duct dilatation. Branch duct IPMT demonstrates cystic side branch dilatation with a normal caliber main duct. A thick wall or nodular component can also be seen. The large intraductal filling defect represents copious mucinous debris, a finding unique to this lesion. Because of its cystic nature and associated ductal dilatation, differential considerations include pancreatic cystadenoma, pancreatic pseudocyst, and true pancreatic cyst. Cystadenomas and true cysts, unlike IPMT, do not demonstrate communication with the pancreatic ductal system or associated ductal dilatation. IPMT can be very difficult to differentiate from pseudocysts. Demonstration of a nodular component, copious intraductal debris, or bulging into the duodenal lumen point toward IPMT. Due to the low grade nature of this malignancy, it carries a better prognosis than pancreatic adenocarcinoma.

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