INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM Figure 6-14 INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM Large papillary neoplastic projections in a fistula connecting the main pancreatic duct with a bile duct that is obstructed by neoplastic tissue and mucin and shows prestenotic dilatation. The two probes a... More

INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM Figure 6-17 INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM Exuberant papillary projections fill the involved duct. More

INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM Figure 6-28 INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM Neoplastic papillary epithelium extends into secondary ducts. Fibrosis and atrophy of the surrounding parenchyma, with lymphocytic infiltrates. More

INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM, LOW GRADE Figure 6-39 INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM, LOW GRADE Left: A papillary cluster with columnar epithelium from an IPMN. The elongated nuclei are crowded and some nuclei have lost basal orientation. Right: Sheets of epithelium from a low-... More

INTRADUCTAL PAPILLARY SQUAMOUS NEOPLASM Figure 6-62 INTRADUCTAL PAPILLARY SQUAMOUS NEOPLASM Left: The papillary neoplasm projects into the lumen of a dilated duct. Right: Papillae are lined by nonkeratinized stratified squamous epithelium with intraepithelial microcysts. There is little nuclear ... More

INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM (IPMN) Figure 6-1 INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM (IPMN) Left: On computerized tomography (CT) scan, a branch duct-type IPMN appears as a cyst in the uncinate process (arrow). Right: The main pancreatic duct is massively dilated for the full length... More

INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM Figure 6-2 INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM Endoscopic view demonstrates a prominent ampulla of Vater and copious mucin pouring into the duodenum. More

INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM Figure 6-3 INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM Magnetic resonance cholangiopancreatography (MRCP) shows a markedly dilated pancreatic duct and side branches. (Courtesy of Dr. S. S. Siegelman, Baltimore, MD) More

INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM Figure 6-4 INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM Per-oral pancreatoscopy visualizes the papillae within the dilated duct. More

MAIN DUCT-TYPE INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM Figure 6-5 MAIN DUCT-TYPE INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM Left: Longitudinal section of the main pancreatic duct before it enters the ampulla. The duct epithelium has a thickened, almost velvety appearance. (Courtesy of Dr. B. Feyerab... More

BRANCH DUCT-TYPE INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM Figure 6-6 BRANCH DUCT-TYPE INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM Left: Longitudinal section of the main duct (arrow) shows a connection to the cystic branch duct. Right: If the connection to the main duct is not demonstrated, branch duc... More

BRANCH DUCT-TYPE INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM Figure 6-7 BRANCH DUCT-TYPE INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM Some cases show multicentricity, with multiple cystic branch ducts separated by uninvolved parenchyma. More

BRANCH DUCT-TYPE INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM Figure 6-8 BRANCH DUCT-TYPE INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM A unilocular example grossly mimics a retention cyst. Intraductal papillae are not grossly evident. Note the uninvolved main pancreatic duct. More

INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM Figure 6-9 INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM Some ducts contain abundant exophytic masses (left), occasionally completely obliterating the duct lumen (right, arrow). (Right: Courtesy of Dr. E. Dankoweit-Timpe, Hannover, Germany) More

INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM Figure 6-10 INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM Submersion under water allows three-dimensional visualization of the projecting papillary structures. More

INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM EXTENDING TO THE AMPULLA OF VATER Figure 6-11 INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM EXTENDING TO THE AMPULLA OF VATER A: The neoplasm creates a mucosal bulge at the papilla of Vater, with mucin oozing through the ampulla (arrow). B: Numerous papillary pr... More

INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM WITH ASSOCIATED TUBULAR-TYPE INVASIVE CARCINOMA Figure 6-12 INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM WITH ASSOCIATED TUBULAR-TYPE INVASIVE CARCINOMA A dilated branch duct (long black arrow) contains intraductal papillary tumor tissue and shows accompanying i... More

INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM WITH ASSOCIATED COLLOID-TYPE INVASIVE CARCINOMA Figure 6-13 INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM WITH ASSOCIATED COLLOID-TYPE INVASIVE CARCINOMA A papillary structure is seen within a dilated duct (arrow). The surrounding pancreas contains pools of glist... More

INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM, GASTRIC TYPE Figure 6-15 INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM, GASTRIC TYPE Multilocular grape-like cystic lesions are in the peripheral tissue of the pancreatic head, adjacent to the duodenum. More

INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM Figure 6-16 INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM Cross-section of distended main pancreatic duct (upper right), which is lined by papillary projections. Extension into secondary duct (bottom left). The stroma at the right contains small acellular mucin l... More