胰腺导管内乳头状黏液性肿瘤的病理学及影像学进展

Research progress in pathology and imaging of intraductal papillary mucinous neoplasms of the pancreas

胰腺导管内乳头状黏液性肿瘤(IPMN)是具有一定恶性潜能的胰腺囊性肿瘤,根据胰管扩张程度及肿瘤所在位置分为主胰管型、分支胰管型及混合型IPMN,根据异型程度分为低度异型增生、重度异型增生及浸润性IPMN。根据组织学形态及免疫组化分为胃型、肠型、胰胆管型、嗜酸细胞型4种亚型。超声是筛查和随访的常用工具,CT、MRI/MRCP及EUS可识别具有高危特征及令人焦虑特征的IPMN患者,对手术时机的选择和患者的随访有重要价值。影像组学评估异型增生程度准确性较高,识别恶变高危人群。结合近年相关指南及文献,对IPMN的临床表现、病理学及影像学特征进行综述,加深对IPMN的认识,以提高影像诊断的准确率。

Intraductal papillary mucinous neoplasm(IPMN)of the pancreas is a cystic tumor of the pancreas with some malignant potential.According to the degree of pancreatic duct expansion and the location of the tumor,it can be divided into main-duct type,branch-duct type,and mixed type.According to the degree of atypia,it can be classified as low-grade dysplasia,high-grade dysplasia,or invasive IPMN.According to histological morphology and immunohistochemistry,there are four subtypes:gastric type,intestinal type,pancreaticobiliary type,and eosinophilic type.Ultrasound is commonly used in screening and follow-up,while CT,MRI/MRCP,and EUS can identify IPMN with high-risk and anxiety characteristics,which are valuable in determining the timing of surgery and patient status.Imaging omics is highly accurate in assessing the degree of dysplasia and can be used to identify people at high risk of malignant transformation.In this article,the clinical manifestations,pathology,and imaging features of IPMN are reviewed in the light of the relevant guidelines and literature in recent years,in order to deepen our understanding of IPMN and thus improve the accuracy of imaging diagnosis.