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会计学定义特点病理CTscanoftheindividualD:presenceofa20mmBD-IPMNinthebodyofthepancreas(whitearrow).Main-ductintraductalpapillarymucinoustumor(IPMT)withmarkedlydilatedpancreaticductwithpapillaryprojectionsthatenhanceoncontrast-enhancedCTMRCP：acysticlesionintheuncinateprocessofthepancreas(asterisk)andacommunicatingbranchduct(arrow)betweenthecystandthenormalcalibermainpancreaticduct.ThesefindingsarecharacteristicofabranchductintraductalpapillarymucinousneoplasmandthislesionhasbeenstableonfollowupMRCPexaminationsfor3years.ERCPshowsopacificationofthecysticlesionandthefocallydilatedmainpancreaticductnearthecysticlesion.影像表现C,HelicalCTscanshowscommunication(straightarrow)betweendilatedmainpancreaticduct(curvedarrow)andcysticlesion(arrowhead).D,Histologicspecimenshowscommunication(straightarrow)betweenmainpancreaticduct(curvedarrow)andcysticlesion(arrowhead)coveredbypapillaryepitheliumsmallerthan1mm.(HandE,×1)1.Naturalhistory(1)Medianage61–68years(2)PatientswithmalignantIPMNsareabout5yearsolderascomparedwiththosewithbenignIPMNs2.Clinicalsymptoms(1)Obstructivejaundice(2)Epigastricpain(3)Weightloss(4)Diabetes3.Imaging1)ThemainductandcombinedtypesofIPMNshaveahigherriskofassociatedalignancyascomparedwiththebranch-ducttype2)MarkeddilatationofthemainpancreaticductisassociatedwithmalignancyinIPMNs3)Presenceofthickeningmural,largenodulesorasolidmassissuggestiveofmalignancyinIPMNs4)IPMNswithcommonbileductobstructionmayindicatetheoccurrenceofinvasivecancer5)IPMNsinvadingadjacentstructures,suchastheduodenum,majorvascularstructures6)Lymphnodemetastases,livermetastasesorperitonealdeposits4.FNAC/B（细针穿刺活检）(1)Cytologicalexaminationofpancreaticjuice(presenceofmalignantcells)identifiedasanindependentpredictorofinvasiveIPMNs(2)MUC1expressionDiagnosisofmalignantorinvasiveIPMNs.CT检查对术前区分良、恶性IPMTAxialT2-weighted(A)andsubtraction(post-contrastminusprecontrast)(B)imagesatthelevelofthepancreas：markedenlargementofthemainpancreaticduct(arrowheads)withintraluminalenhancingpapillaryprojecti
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