How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask BMW MD Your Own Question

BMW MD
BMW MD, Doctor
Category: Medical
Satisfied Customers: 1597
Experience:  AP/CP BE Pathologist, Harvard trained BE Molecular Genetic Pathologist
Type Your Medical Question Here...
BMW MD is online now
A new question is answered every 9 seconds

I have been told that I have benign IPMN of pancreas after

Resolved Question:

I have been told that I have benign IPMN of pancreas after EUS
I was just told 2nd opinion that pathology is benign glandular cell in sheets and clusters
Are these statements contadictory or is there a relationship between IPMN anglandular cells thank you
Submitted: 4 years ago.
Category: Medical
Expert:  BMW MD replied 4 years ago.
Hello. I would be happy to try to answer your question.

I understand how this can be confusing for you, as it is for many pathologists.

IPMN is a precancerous lesion with a well described adenoma carcinoma sequence. However, the rate of progression appears to be extremely slow (approximately 15 to 20 years). As many as 70% of main duct type intraductal papillary mucinous neoplasms harbor high-grade dysplasia (the step right before an invasive cancer develops) or an invasive cancer. Main duct type IPMNs are therefore significant lesions, and, in general, most main duct intraductal papillary mucinous neoplasms should be surgically resected if the patient can safely tolerate surgery.

Therefore IPMN is NOT benign. It is precancerous. The cells of your second opinion are the cells that are there in a normal pancreas. IPMN cells have taken the next step, so to speak, towards malignancy. There is no way for me to know what you have without seeing the pathology slides personally. You may wish to seek a third opinion given that the two opinions you have do not agree.

IPMN has most commonly been described in individuals between the ages of 60 and 70 years, most of whom have a long-standing history of recurrent acute pancreatitis or symptoms suggestive of chronic obstructive pancreatitis due to intermittent obstruction of the pancreatic duct with mucus plugs.

I hope this helps. I put a good amount of thought and care in to my answer. Please be respectful of my time and effort, and if satisfied, please click ACCEPT so I may be paid for my work. A bonus is always appreciated. Use of this service does not constitute any doctor-patient relationship, nor does it allow for confidentiality. I assume no medico-legal responsibility. If anything is unclear, please ask for clarification.

Take good care, and best wishes.
BMW, MD

Expert:  BMW MD replied 4 years ago.
Hello. I see that you have viewed my answer. Is there something unclear with my answer?

Please let me know why you are not accepting so that I may help you, and improve my answers for others. You may not realize this, but I, as the expert, only am paid if you accept. More than that, I want to be sure you are getting the answer you needed.


BMW MD
Customer: replied 4 years ago.
I will be glad to pay in just a moment
one more question to be complete then

IPMN and glandular cells are different entities????
one cannot be within the other????
Customer: replied 4 years ago.
I will be glad to pay in just a moment one more question to be complete then IPMN and glandular cells are different entities???? one cannot be within the other????
Expert:  BMW MD replied 4 years ago.
Hello.

They are not different. Glandular cells are what are normally present in the pancreas. These cells go on to become IPMN. I hope that makes sense.

IPMN are glandular cells that have taken the next step and become more disorganized, or more angry looking, and are now considered pre-cancerous.

I hope this answers your question. I apologize if I was not clear the first time.

BMW MD
Customer: replied 4 years ago.
Now I get it but why would a Fine Needle Biopsy reveal IPMN and then pathology from slides show glandular...it doesn't make sense
Expert:  BMW MD replied 4 years ago.
Hello.

Well, cytology and FNA (needle) look at the individual cells. This is commonly used for Pap smears to look for pre cancerous or cancerous cells of the cervix.

Surgical pathology (slides) look at the cells in a more anatomic fashion; meaning that we look at the architecture of the bad cells, and all the cells around the bad cells to make a diagnosis. This is commonly done as a biopsy or slice of a lesion.

These diagnoses are very similar and hard to differentiate. As I mentioned, they are sort of shades of the same color. What person A sees as azure, person B may see as teal. They would both be correct in saying the item is blue, but only one is correct.

I know this is confusing, but that is why some crazy people like me go to school forever to become pathologists!

I hope this helps, and best wishes to you.
BMW MD
BMW MD, Doctor
Category: Medical
Satisfied Customers: 1597
Experience: AP/CP BE Pathologist, Harvard trained BE Molecular Genetic Pathologist
BMW MD and 5 other Medical Specialists are ready to help you

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me from a serious, even life threatening situation. I am very grateful to the experts who answered me. Susan O. USA
< Last | Next >
  • I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me from a serious, even life threatening situation. I am very grateful to the experts who answered me. Susan O. USA
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
 
 
 

Meet The Experts:

 
 
 
  • Dr. Thomas, MD

    Board Certified Physician

    Satisfied Customers:

    46349
    Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
< Last | Next >
  • http://ww2.justanswer.com/uploads/DR/DrThomasMd/2012-7-25_134438_Imagess1.64x64.jpg Dr. Thomas, MD's Avatar

    Dr. Thomas, MD

    Board Certified Physician

    Satisfied Customers:

    46349
    Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
  • http://ww2.justanswer.com/uploads/MY/mysticdoc/2012-6-8_15615_mysticdoc3.64x64.jpg Dr. D.J.'s Avatar

    Dr. D.J.

    Board Certified Physician

    Satisfied Customers:

    14679
    MD
  • http://ww2.justanswer.com/uploads/agketch/2008-7-14_184046_drketchresized.jpg Dr. Ketch's Avatar

    Dr. Ketch

    Board Certified Physician

    Satisfied Customers:

    76
    Medical Degree, Former Assistant Professor at School of Medicine at Yale University
  • http://ww2.justanswer.com/uploads/FA/FamilyPhysician/2013-8-31_191624_JA550x500Photo.64x64.jpg Family Physician's Avatar

    Family Physician

    Doctor

    Satisfied Customers:

    2562
    Emergency Medicine and Family Practice for over 26 years
  • http://ww2.justanswer.com/uploads/DR/drappapo/2013-8-16_22576_drdavid.64x64.jpg Dr. David's Avatar

    Dr. David

    Board Certified Physician

    Satisfied Customers:

    224
    Treat children/young adults, former chief resident, multiple publications
  • http://ww2.justanswer.com/uploads/DrDLove/2009-08-12_141522_DrDLove.jpg Dr. D. Love's Avatar

    Dr. D. Love

    Doctor

    Satisfied Customers:

    11961
    Family Physician for 10 years; Hospital Medical Director for 10 years.
  • http://ww2.justanswer.com/uploads/CO/commissure/2011-4-15_192514_REISD20080926JR1090.64x64.jpg Dr. David's Avatar

    Dr. David

    Board Certified Physician

    Satisfied Customers:

    10667
    Experienced Physician trained in New York City. I'm ready to help.