The quantum physics of intraductal papillary mucinous neoplasm of the pancreas
Abstract
In 1997, a 54 year old woman underwent pancreatoduodenectomy at Verona University Hospital for a 3-cm periampullary cyst with a solid component. The final pathology reported a peripheral intraductal papillary mucinous neoplasm (IPMN) with low-grade dysplasia. The pancreatic margins were free from neoplastic cells. After 22 years of clinical and radiological surveillance, the same person, now 76 years old, presented at the same Hospital with increased CA19-9 levels and an abdominal MRI showing a 4-cm cyst, with an enhancing solid component, in the retro-portal lamina area next to the superior mesenteric vessels. A ‘recurrence’ of the original IPMN was found in the context of a small fragment of uncinate process, left in place during the first surgery. Despite the concerning radiographical and serological features, final pathology found an IPMN of intestinal type with—again—only low-grade dysplasia. The scientific literature on IPMNs has come a long way since 1997. Recently, the largest series of IPMNs ever resected by a single referral centre was published1. In this study, among 1439 patients, the timing of resection was categorized according to final pathology: too early (low-grade dysplasia); too late (invasive cancer); and timely (intermediate- and high-grade dysplasia). Only 34 per cent of the ‘timely’ group had radiographical criteria of suspicion, and 25 per cent of the ‘too late’ group was in a watch-and-wait policy before resection. The authors therefore conclude that…
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