Depending on the degree of ductal dilatation, IPMNs vary in size from 1 to 8 cm in maximum dimension {17}. They are cystic and may appear multiloculated if branch ducts are involved. The mucin found in IPMN is viscous or sticky and can dilate parts of the duct that are lined by normal appearing epithelium. The lining of cystic spaces may be smooth and glistening, granular, or velvet-like, the latter reflecting papillary growth. When

Fig. 10.22 Intraductal papillary mucinous neoplasm in the main pancreatic duct (arrowhead).

papillary growths are large, the dilated ducts may show localized excrescences or be filled with soft papillary masses of tissue.

The pancreatic parenchyma surrounding and retrograde to the tumour is often pale and firm, reflecting changes of chronic obstructive pancreatitis. When there is invasion, gelatinous areas may be identified in fibrotic tissue.

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