Intraductal oncocytic papillary neoplasm of the pancreas: clinical and radiological features compared to those of intraductal papillary mucinous neoplasm

• Published in: Abdominal imaging 2023-08, Vol.48 (8), p.2483-2493
• Main Authors: Nakaya, Moto, Nakai, Yudai, Takahashi, Mai, Fukukura, Yoshihiko, Sato, Keisuke, Kameda, Arisa, Tashiro, Yuki, Kageyama, Sakiko, Sofue, Keitaro, Nakano, Tsubasa, Yoshimitsu, Kengo, Marugami, Nagaaki, Takeyama, Nobuyuki, Tanaka, Mariko, Hasegawa, Kiyoshi, Watadani, Takeyuki
• Format: Article
• Language: English
• Subjects: Antigens; Bile ducts; Cancer; Carcinoembryonic antigen; Computed tomography; Cysts; Emission analysis; Gastroenterology; Hepatology; Imaging; Lesions; Magnetic resonance imaging; Medical imaging; Medical prognosis; Medicine; Medicine & Public Health; Neoplasia; Pancreas; Patients; Positron emission; Positron emission tomography; Radiology; Sialyl Lewis a antigen; Special Section: Distinguished Papers from JSAR; Tomography; Tumors
• ISSN: 2366-0058; 2366-004X; 2366-0058
• DOI: 10.1007/s00261-023-03985-z

Purpose This study aimed to characterize the clinical and imaging findings of intraductal oncocytic papillary neoplasm of the pancreas (IOPN-P) compared to those of intraductal papillary mucinous adenoma/carcinoma (IPMA/IPMC). Methods This multi-institutional retrospective study reviewed the clinical, imaging, and pathological findings of 21 patients with pathologically proven IOPN-P. Twenty-one computed tomography (CT) and magnetic resonance imaging, and seven 18 F-fluorodeoxyglucose (FDG)-positron emission tomography were performed before surgery. The following findings were evaluated: preoperative blood test results, lesion size and location, pancreatic duct diameter, contrast-enhancement effect, bile duct and peripancreatic invasion, maximum standardized uptake (SUVmax) value, and pathological stromal invasion. Results Serum carcinoembryonic antigen (CEA) and cancer antigen 19-9 (CA19-9) levels were significantly higher in the IPMN/IPMC group than in the IOPN-P group. Except in one patient, IOPN-P showed multifocal cystic lesions with solid components or a tumor in the main pancreatic duct (MPD) with dilatation. IOPN-P had a higher frequency of solid parts and a lower frequency of downstream MPD dilatation than IPMA. IPMC showed smaller overall cyst size, more radiological peripancreatic invasion, and worse recurrence-free and overall survival than IOPN-P. The average SUVmax value of IOPN-P was 7.5. Pathologically, 17 of the 21 IOPN-Ps had a malignant component, and six showed stromal invasion. Conclusion IOPN-P shows cystic-solid lesions similar to IPMC but has lower serum CEA and CA19-9 levels, larger overall cyst size, lower frequency of peripancreatic invasion, and more favorable prognosis than IPMC. Moreover, the high FDG uptake by IOPN-Ps may be a characteristic finding of this study. Graphical abstract