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会计学定义特点病理CTscanoftheindividualD:presenceofa20mmBD-IPMNinthebodyofthepancreas(whitearrow).Main-ductintraductalpapillarymucinoustumor(IPMT)withmarkedlydilatedpancreaticductwithpapillaryprojectionsthatenhanceoncontrast-enhancedCTMRCP：acysticlesionintheuncinateprocessofthepancreas
(asterisk)andacommunicatingbranchduct(arrow)betweenthecyst
andthenormalcalibermainpancreaticduct.
ThesefindingsarecharacteristicofabranchductintraductalpapillarymucinousneoplasmandthislesionhasbeenstableonfollowupMRCPexaminationsfor3years.ERCPshowsopacificationofthecysticlesionandthefocallydilatedmainpancreaticductnearthecysticlesion.影像表现C,HelicalCTscanshowscommunication(straightarrow)betweendilatedmainpancreaticduct(curvedarrow)andcysticlesion(arrowhead).
D,Histologicspecimenshowscommunication(straightarrow)betweenmainpancreaticduct(curvedarrow)andcysticlesion(arrowhead)coveredbypapillaryepitheliumsmallerthan1mm.(HandE,×1)1.Naturalhistory
(1)Medianage61–68years
(2)PatientswithmalignantIPMNsareabout5yearsolderascomparedwiththosewithbenignIPMNs
2.Clinicalsymptoms
(1)Obstructivejaundice(2)Epigastricpain(3)Weightloss(4)Diabetes
3.Imaging
1)ThemainductandcombinedtypesofIPMNshaveahigherriskofassociatedalignancyascomparedwiththebranch-ducttype
2)MarkeddilatationofthemainpancreaticductisassociatedwithmalignancyinIPMNs
3)Presenceofthickeningmural,largenodulesorasolidmassissuggestiveofmalignancyinIPMNs
4)IPMNswithcommonbileductobstructionmayindicatetheoccurrenceofinvasivecancer
5)IPMNsinvadingadjacentstructures,suchastheduodenum,majorvascularstructures
6)Lymphnodemetastases,livermetastasesorperitonealdeposits
4.FNAC/B（细针穿刺活检）
(1)Cytologicalexaminationofpancreaticjuice(presenceofmalignantcells)identifiedasanindependentpredictorofinvasiveIPMNs
(2)MUC1expression
DiagnosisofmalignantorinvasiveIPMNs.CT检查对术前区分良、恶性IPMTAxialT2-weighted(A)andsubtraction(post-contrastminusprecontrast)
(B)imagesatthelevelofthepancreas：markedenlargement
ofthemainpancreaticduct(arrowheads)withintraluminalenhancing
papillaryprojecti