Confocal Endomicroscopy Characteristics of Different Intraductal Papillary Mucinous Neoplasm Subtypes

Abstract

Intraductal papillary mucinous neoplasms are classified into gastric, intestinal, pancreatobiliary, and oncocytic subtypes where morphology portends disease prognosis. The study aim was to demonstrate EUS-guided needle-based confocal laser endomicroscopy imaging features of intraductal papillary mucinous neoplasm subtypes. Four subjects, each with a specific intraductal papillary mucinous neoplasm subtype were enrolled. An EUS-guided needle-based confocal laser endomicroscopy miniprobe was utilized for image acquisition. The mean cyst size from the 4 subjects (2 females; mean age = 65.3±12 years) was 36.8±12 mm. All lesions demonstrated mural nodules and focal dilation of the main pancreatic duct. EUS-nCLE demonstrated characteristic finger-like papillae with inner vascular core for all subtypes. The image patterns of the papillae for the gastric, intestinal, and pancreatobiliary subtypes were similar. However, the papillae in the oncocytic subtype were thick and demonstrated a fine scale-like or honeycomb pattern with intraepithelial lumina correlating with histopathology. There was significant overlap in the needle-based confocal laser endomicroscopy findings for the different intraductal papillary mucinous neoplasm subtypes; however, the oncocytic subtype demonstrated distinct patterns. These findings need to be replicated in larger multicenter studies.

Keywords: Confocal; Microscopy; Pancreatic Neoplasms.

Conflict of interest statement

Conflicts of Interest The authors have no conflicts of interest to report.

Figures

Figure 1

A comparison of the needle-based confocal laser endomicroscopy and histopathology findings for pancreatobiliary, gastric, intestinal, and oncocytic subtypes of intraductal papillary mucinous neoplasms: the oncocytic IPMN subtype demonstrates papillae with multiple fine clefts and scale-like appearance due to characteristic intraepithelial lumina.

Figure 2

Oncocytic subtype intraductal papillary mucinous neoplasm demonstrating intraepithelial lumina (yellow arrows). The entire papilla of interest is bounded by the green arrows. There is good correlation between needle-based confocal laser endomicroscopy and histopathology findings.