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10 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
Intraductal papillary mucinous neoplasms are fluid-filled growths in the pancreatic ducts that make mucus and can slowly turn into pancreatic cancer, one of the few chances to catch pancreatic cancer before it starts. Most are watched with scans for years, and surgery is reserved for the ones with warning signs such as a widened main duct, a solid nodule inside the cyst or jaundice.
Intraductal papillary mucinous neoplasm (IPMN) is a mucin-producing epithelial neoplasm growing within the main pancreatic duct, its side branches or both. Main-duct and mixed-type IPMNs carry a substantial risk of high-grade dysplasia or invasive cancer at resection; branch-duct IPMNs, the commonest incidental cyst, progress in only a small minority over years. Mucinous cystic neoplasms (MCNs) occur almost only in women, in the body or tail, and have ovarian-type stroma; serous cystadenomas are benign and linked to VHL; solid pseudopapillary neoplasms are low-grade tumours of young women driven by CTNNB1. IPMNs carry KRAS and GNAS mutations early and acquire TP53, CDKN2A and SMAD4 changes as they progress, and cyst fluid analysis for CEA, glucose and mutations helps tell mucinous from non-mucinous cysts.
Management follows the international Fukuoka and Kyoto (2024) guidelines and the European consensus. High-risk stigmata (obstructive jaundice from a head cyst, an enhancing mural nodule of 5 mm or more, main duct of 10 mm or more, or positive cytology) call for resection in fit patients. Worrisome features (cyst of 3 cm or more, thickened enhancing wall, main duct 5 to 9 mm, smaller nodules, rapid growth, raised CA 19-9, new diabetes, pancreatitis) lead to endoscopic ultrasound with fluid sampling and closer surveillance. Cysts without these features are followed with MRI or endoscopic ultrasound at intervals set by size, and the question of when surveillance can stop in older patients with stable small cysts is unresolved.
| Setting | Approach | Guideline |
|---|---|---|
| Incidental cyst | Characterise with MRI and MRCP or pancreas-protocol CT; endoscopic ultrasound with fluid analysis when the cyst type is unclear or worrisome features are present. | not mapped |
| High-risk stigmata | Resection (pancreatoduodenectomy or distal pancreatectomy) for obstructive jaundice, an enhancing mural nodule of 5 mm or more, a main duct of 10 mm or more, or positive cytology, in patients fit for surgery. | not mapped |
| Worrisome features | Endoscopic ultrasound and fluid sampling; resection or short-interval surveillance depending on findings, age and fitness. | not mapped |
| Surveillance | MRI or endoscopic ultrasound at intervals set by cyst size, continued while the patient remains a surgical candidate; the remaining pancreas is followed after resection. | not mapped |
| Invasive carcinoma in an IPMN | Staged and treated as pancreatic ductal adenocarcinoma with resection and adjuvant chemotherapy. | not mapped |