췌관내 유두상 점액 종양의 임상상 및 병리학적 특징: 악성 종양 예측인자를 중심으로
Clinicopathological features of intraductal papillary mucinous neoplasms of the pancreas: an emphasis on predictors of malignancy
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목적 : 췌관내 유두상 점액 종양(intraductal papillary mucinous neoplasm of the pancreas, IPMN)은 비교적 근래 들어 알려진 췌장의 종양이다. 본 연구는 IPMN의 임상적, 병리학적 특징을 살펴보고, 악성 IPMN의 예측인자를 확인하고자 시행되었다. 방법 : 1993년부터 2004년까지 IPMN으로 진단된 91명의 환자(남:여=55:36, 평균 연령 61.6세)를 대상으로 임상적, 병리학적 특징을 조사하였다. 결과 : 58명의 환자는 우연히 IPMN이 발견되었으며, 33명의 환자는 증상 또는 징후가 있어서 IPMN이 발견되었다. 내시경검사에서 20명의 환자에서 십이지장 유두 개구부를 통해 점액이 흘러나오는 것을 확인할 수 있었다. 병리학적 진단은 선종 19예, 중등도 이형성을 보이는 종양 50예, 비침습성 암종 8예, 침습성 암종이 14예였다. 주췌관형 및 혼합형 IPMN에서는 유두 개구부를 통해 점액이 흘러나온 경우 악성 IPMN과 경계역의 유의함을 보였으며, 악성 IPMN이 양성 IPMN에 비해 종양의 평균 장경이 유의하게 길었다(≥30 mm). 분지췌관형 IPMN에서 악성 IPMN과 연관이 있는 인자는 증상 또는 징후가 있는 경우, 벽결절의 존재였으며, 악성 IPMN이 양성 IPMN에 비해 종양의 평균 장경(≥27 mm) 및 주췌관의 평균 장경(= 4 mm)이 유의하게 길었다. 결론 : 주췌관형 및 혼합형 IPMN에서는 종양의 평균 장경이 클수록(≥30 mm) 악성 IPMN과 연관이 있었으며, 분지췌관형 IPMN에서는 증상 또는 징후가 있는 경우, 벽결절의 존재, 종양(≥27 mm) 및 주췌관의 평균 장경(≥4 mm)이 클수록 악성 IPMN과 연관이 있었다.
Abstract
Background : Intraductal papillary mucinous neoplasm of the pancrea (IPMN) is a newly recognized category of pancreatic exocrine tumors with a favorable prognosis. We conducted this study to evaluate clinicopathological features of IPMNs and to evaluate clinical factors associated with malignant IPMNs. Methods : We retrospectively evaluated 91 patients (55 males, mean age 61.6 years) who were diagnosed with IPMNs with histological confirmation from 1993 to 2004. Results : Fifty-eight cases were incidentally found, whereas 33 cases were symptomatic. Pathology revealed adenoma in 19 cases, IPMN with moderate dysplasia in 50 cases, noninvasive carcinoma in 8 cases, and invasive carcinoma in 14 cases. In main duct type (n=13) and combined type IPMNs (n=5), visible mucin secretion as seen on endoscopy indicated a borderline association with malignancy; a large tumor diameter (≥30 mm) was associated with malignancy. In branch duct type IPMNs (n=73), the presence of symptoms or signs, the presence of mural nodules, a large tumor diameter (≥27 mm) and a larger main pancreatic duct diameter (≥4 mm) were associated with malignancy. Conclusions : In IPMNs involving the main pancreatic duct, a large tumor diameter (≥30 mm) is associated with malignancy. In branch duct type IPMNs, the presence of symptoms or signs, the presence of mural nodules, a large tumor diameter (≥27 mm) and a large main pancreatic duct diameter (≥4 mm) are associated with malignancy.(Korean J Med 72:272-280, 2007)
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