Intraductal Papillary Mucinous Neoplasm as a Precursor to Pancreatic Cancer

Abstract

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a mucin-producing cystic tumor that serves as a significant precursor to pancreatic ductal adenocarcinoma (PDAC). The increasing recognition of IPMN is due to advancements in diagnostic imaging and a deeper understanding of its distinct characteristics. This review aims to consolidate current knowledge on IPMN, focusing on its pathogenesis, epidemiology, clinical manifestations, complications, diagnostic challenges, management, and prognosis. The pathogenesis of IPMN involves genetic mutations such as KRAS, GNAS, and RNF43, which disrupt cellular signaling pathways, leading to mucinous epithelial proliferation and cystic dilation. Epidemiologically, IPMN exhibits varying incidence and prevalence globally, with notable differences based on age, sex, and ethnicity. The clinical presentation of IPMN is often asymptomatic, but when symptoms occur, they are typically nonspecific and can include abdominal pain, weight loss, and new-onset diabetes mellitus. The potential complications of IPMN include pancreatic insufficiency, pancreatitis, and malignant transformation to PDAC. Accurate diagnosis involves a combination of advanced imaging techniques, endoscopic ultrasound, and molecular testing. Management strategies range from monitoring and pharmacological therapy to surgical and non-surgical interventions, with surgical resection recommended for high-risk IPMNs. Despite advancements in therapeutic approaches, gaps remain in understanding the variability of clinical outcomes and the effectiveness of treatment options. Future research should focus on refining diagnostic tools, exploring the molecular and genetic basis of IPMN, and developing targeted therapies to improve early detection and treatment. Enhanced policy support and continued research are essential to improve the management and prognosis of patients with IPMN, ultimately aiming to enhance patient outcomes and inform future therapeutic strategies.