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Intraductal Papillary Mucosal Neoplasm (IPMN)
Intraductal Papillary Mucosal Neoplasms Intraductal Papillary Mucosal Neoplasms (IPMNs) are precancerous cysts or neoplasms in pancreatic ducts. The expression "papillary" refers to the type of a cell structure in mucus producing cysts. IPMN can develop anywhere in the ductal region of the pancreas.
IPMNs are surprisingly common both in men and women and increase prevalence with advancing age. These are slow-growing neoplasms (re-occurring) and patients usually perfect outcome after treatment. Surgical treatment is the first line treatment to prevent conversion to cancerous tumor (s), as most IPMN shows high grade dysplasia (abnormal cell growth).
IPMN Symptoms
Usually IPMNs have no symptoms. They are detected accidentally by CT or MRI during routine examinations or examinations for other causes. IPMNs and other bile duct dysorders have the same symptoms, as some bile ducts secrete bile or digestive substances into the duodenum. The most common complaints caused by IPMNs are:
- Abdominal pains on the right side (region of liver, gall bladder and pancreas)
- Nausea
- Vomiting
- Jaundice in eyes and skin (accumulation of bilirubin, residue)
- Pancreatitis
- Fatigue
- Weight loss
- Fever
- Overnight sweating
- Loss of appetite
- Light colored defecation
Diagnosis
Blood tests
The accumulation of bilirubin in the blood causes yellowness of eyes and skin. In addition to bilrubin analysis, analysis of the presence of high white blood cells, abnormal pancreatic and hepatic values is also required. Your doctor may also require CA19-9 blood test for tumor markers observed in problems in the bile ducts.
Abdominal ultrasonography
To obtain these images, sound waves are used more than X-rays. Images may indicate obstruction in the bile duct. During this examination, the USE probe is put on the abdomen and the images are transferred to the computer. Abdominal USE is commonly used at pregnant women.
Abdominal CT scan or MRI
Abdominal CT scan or MRI can determine stenosis in the bile ducts. Both scans are non-invasive procedures in which bile duct images are shown on a computer monitor.
ERCP
Endoscopic Examination and ERCP: Endoscopic retrograde cholangiopancreatography or ERCP is a special endoscopic method used to study gall bladder, pancreas and bile ducts and is a treating tool. EDCP is used for more than 30 years and is accepted as a standard method for the diagnosis and treatment of gall bladder diseases. During ERCP, along with a light anaesthetic substance, the patients are given anaesthesia for numbing the throat.
Afterwards, your gastroenterologist enters the stomach and intestine through the mouth with an endoscope with a mobile camera anaesthesia. When your gastroenterologist sees the gall - bladder and pancreas ducts on the monitor, he\she enters a smaller catheter with a contrast fluid. The contrast fluid is injected to the pancreas and the gall bladder and x-rays displayed on the computer monitor are obtained. The procedure lasts between 60 and 90 minutes.
Endoscopic USE and ERCP
Recently, endoscopic USE is used instead of X-rays for better visualization of bile ducts and pancreatic ducts. During this examination, an ultrasound probe is put on ERCP and images are transmitted to the computer.
Fine Needle Aspiration Biopsy
Fine Needle aspiration biopsy and tissue sampling is possible by endoscopy to facilitate diagnosing. This can be done with a thin needle through the abdominal skin (percutaneously). The percutaneous procedure is guided by needle placement near the pancreatic duct, by ultrasound or CT scan.
Magnetic Resonance Collagenopancreaticography (MRCP)
Magnetic Resonance Collagenopancreaticography (MRCP) is a new technology. This non-invasive diagnostic method is performed in radiology using MRI technology (magnets and radio waves) to produce computer images of bile ducts. Inject the contrast dye before the abdominal skin to enhance the pictures. Patients do not need to be prepared for endoscopy and are not subject to sedation. MRCP is especially used in patients who have failed or are not good candidates for ERCP, who don’t want to be undergone to an endoscopic procedure and who are at low risk of pancreatic duct or bile duct dysfunction. While ERCP allows treatment options with colonoscopy, MRCP is only a diagnostic tool.
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