Use of extended criteria donors (ECD) may lead to increased transmission of donor-derived malignancies. Intra-ductal papillary mucinous neoplasms (IPMNs) of the pancreas are being recognised more frequently due to a higher threshold of awareness and improved diagnosis, but use of deceased donors (DD) with incidental IPMNs may be questionable. Based on the literature, we sought to define an algorithm for use of DD with incidental IPMNs. Four subtypes of IPMNs have been identified: gastric, intestinal, pancreatobiliary and oncocytic. The gastric type consists of small cystic lesions in peripheral branch ducts with low grade atypia, while the other subtypes presenta s larger lesions involving the main duct and connecting branch ducts with marked atypia. These latter types may yeald carcinoma in situ to invasive adenocarcinoma. The progression to carcinoma occurs quickly once moderate dysplasia is found. Approximately 30% of resected IPMNs may harbor synchronous or metachronous tumors in the stomach, colon and rectum. Once an incidental IPMN is discovered, it is imperative to retrieve the whole pancreas and proceed with gross inspection of the gland, with regard to communication of the lesion(s) with the main duct, the presence of mucin, site of the cysts, and size of the involved ducts. Sample coloration with EE allows for identification of IPMN subtypes. Such procedures will help allocate IPMNs to low risk (<3 cm; branch-duct; no main duct dilatation; no mural nodules; gastric type; low dysplasia) or high risk (≥3 cm; main duct(s) involved; other than gastric; other than low dysplasia). Incidental IPMNs in DDs require careful evaluation of potential benefits and risks. Smaller lesions (<3 cm) of the branch ducts, with low dysplasia and of gastric type might be considered, provided careful evaluation of abdominal organs and patient’s consent. A strict follow-up is needed to assess risk in the long term.
Incidental intra-ductal papillary mucinous neoplasms (IPMNs) of the pancreas in deceased organ donors: are such donors unfit for donation?
De Simone P;Campani D;Filipponi F
2011-01-01
Abstract
Use of extended criteria donors (ECD) may lead to increased transmission of donor-derived malignancies. Intra-ductal papillary mucinous neoplasms (IPMNs) of the pancreas are being recognised more frequently due to a higher threshold of awareness and improved diagnosis, but use of deceased donors (DD) with incidental IPMNs may be questionable. Based on the literature, we sought to define an algorithm for use of DD with incidental IPMNs. Four subtypes of IPMNs have been identified: gastric, intestinal, pancreatobiliary and oncocytic. The gastric type consists of small cystic lesions in peripheral branch ducts with low grade atypia, while the other subtypes presenta s larger lesions involving the main duct and connecting branch ducts with marked atypia. These latter types may yeald carcinoma in situ to invasive adenocarcinoma. The progression to carcinoma occurs quickly once moderate dysplasia is found. Approximately 30% of resected IPMNs may harbor synchronous or metachronous tumors in the stomach, colon and rectum. Once an incidental IPMN is discovered, it is imperative to retrieve the whole pancreas and proceed with gross inspection of the gland, with regard to communication of the lesion(s) with the main duct, the presence of mucin, site of the cysts, and size of the involved ducts. Sample coloration with EE allows for identification of IPMN subtypes. Such procedures will help allocate IPMNs to low risk (<3 cm; branch-duct; no main duct dilatation; no mural nodules; gastric type; low dysplasia) or high risk (≥3 cm; main duct(s) involved; other than gastric; other than low dysplasia). Incidental IPMNs in DDs require careful evaluation of potential benefits and risks. Smaller lesions (<3 cm) of the branch ducts, with low dysplasia and of gastric type might be considered, provided careful evaluation of abdominal organs and patient’s consent. A strict follow-up is needed to assess risk in the long term.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
