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Suggest treatment for Intraductal Papillary Mucinious Neoplasia (IPMN)?

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General & Family Physician
Practicing since : 2005
Answered : 1295 Questions
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Respected Sir, My wife had operated gall balder on july 2013. In that time doctor find out that, some polips, solid mass 8mm devlops at pancras which may IPMN. please suggest what can I do further. No she has no problem. we have also CBC report but there is ok. We have find out when first CT scan of abdomen on march 2013. but till date no pancras problem. diabetic level decreases from 180 to 117 as FBS. after removal of gall baldder on may 2013 there found biypc report positive. so please check our status and suggested us what i can we do further. if any medicine has for remove polips from pancras pl suggest us. thanks XXXXXXX
Posted Sun, 26 Jan 2014 in General Health
 
 
Answered by Dr. T Shobha Deepak 1 hour later
Brief Answer: Detailed report and investigation required Detailed Answer: Hi Welcome to Healthcare-Magic Greetings of the day Dear Mr XXXXXXX I would request you to get back to me with complete Pre - operative history including since when she was Diabetes. I would also want to know the pre- operative investigation, intra operative finding and histopathology report of removed specimen. Dob not worry she appears to be fine, which is very much obvious by fall in sugar. It will really be helpful if you could get back with all the details. You can also upload the report and images in the image uploader available on the website. Take care Best Regards Dr T Shobha Deepak MBBS, MD
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Follow-up: Suggest treatment for Intraductal Papillary Mucinious Neoplasia (IPMN)? 10 hours later
Dear Mam, We have send 7 pages of operation history with before CT scan report for your kind information. If required we will send you present blood CBC report which is Ok now. Now patient has no problem but we will fear for cancer in pancras. Pl suggest further.
 
 
Answered by Dr. T Shobha Deepak 2 hours later
Brief Answer: MRCP and further planning for Pancreatic Surgery Detailed Answer: Greetings Dear Mr XXXXXXX Thank you very much for providing detailed reports. After thoroughly going through the report i would advise the following The Post Operative CT scan done shows features suggestive of Intraductal Papillary Mucinious Neoplasia (IPMN). This neoplasia is usually multicentric and may have associated Multiple diffuse microscopic (not visible on CT Scan) carcinoma in situ. If grossly the tumor in localized its better to undergo surgical resection. Exact confirmation of the diagnosis is by Histopathology examination. Although there have been several reports of patients with an IPMN who were followed for years without progression of their disease, some noninvasive IPMNs clearly do progress to invasive cancer over time. Furthermore, the inability preoperatively to determine with certainty whether an invasive carcinoma component is present in an IPMN suggests that the decision to observe a patient with a known IPMN should not be taken lightly. Even if your wife is asymptomatic, whether there is invasive component in the IPMN cannot be determined with certainity by any pre-operative investigation. It is advisable to get Magnetic Resonance Cholangio-pancreatography (MRCP) done to assess the size and to determine the exact extent of the tumor. Exact diagnosis is only by Histopathological examination of ressected specimen of the Pancreas. I suggest you to discuss it with your Gastro-enterlogist and plan further management. Its likely that your Surgeon would have discussed with you the need of surgical resection of Pancreas. In case you need any further assistance, kindly get back to me, will be glad to assist you. Take Care Best Regards Dr T Shobha Deepak MBBS,MD
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Follow-up: Suggest treatment for Intraductal Papillary Mucinious Neoplasia (IPMN)? 19 minutes later
Dear Mam polyps size decreases from 10mm to 8 mm in 5 months of operation. diabetic also reduces. and blood CBC report shows no infection. So, as a lay man , before removal of pancreas we want more conformation. So I am requesting you to kindly suggestions taken from any oncologist Sr professors at your end. Our doctor first says to remove the pancras at the time of gall bladder but after operation, he says there is no infections now. So what I do Mam.. pl suggest.
 
 
Answered by Dr. T Shobha Deepak 12 minutes later
Brief Answer: Evauluation by MRCP required Detailed Answer: Hi, Thanks for your query. Its sometimes difficult to differentiate IPMN from Chronic Pancreatitis, reduction in size is good thing but microscopic malignancy cannot be ruled out. Further it can be evaluated by MRCP, before planning any Surgical intervention. I shall have a word with my Oncologist colleague and get back to you. Do not be worried, I assure you things can be taken care off. I would really appreciate your concern and care for your wife. To enable me to reply back , I would suggest you to write a follow up query to me by the end of day tomorrow, I shall get back. Take Care Best Regards Dr T Shobha Deepak
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