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

EUS I was just told 2nd...
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
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Answered in 20 minutes by:
9/15/2009
BMW MD
BMW MD, Doctor
Category: Medical
Satisfied Customers: 1,597
Experience: AP/CP BE Pathologist, Harvard trained BE Molecular Genetic Pathologist
Verified
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
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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
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Customer reply replied 8 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 reply replied 8 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????
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
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Customer reply replied 8 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
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
BMW MD, Doctor
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Satisfied Customers: 1,597
Experience: AP/CP BE Pathologist, Harvard trained BE Molecular Genetic Pathologist
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