Abstract
Indications for resection of branch duct intraductal papillary mucinous neoplasms (IPMNs) remain controversial because of their low tendency to be malignant. Surgical resection should be recommended if any factors indicating malignancy are present. However, preoperative differentiation between benign and malignant tumors is very difficult, especially in cases of branch duct IPMNs. We herein report a case of branch duct intraductal papillary mucinous adenoma (IPMA) of the pancreas with a large mural nodule of 25 mm. A 74-year-old woman was admitted for examination and treatment for a cystic tumor in the head of the pancreas. Magnetic resonance cholangiopancreatography and computed tomography showed a cystic lesion, 50 mm in diameter, with an irregular mural nodule in the pancreatic head. Endoscopic ultrasonography demonstrated a multicystic tumor connected with the main pancreatic duct (MPD). The mural nodule had a diameter of 18 mm, and the MPD had a slight dilation of 6 mm. These findings suggested a high potential for malignancy. The patient underwent pancreaticoduodenectomy with lymph node dissection. The excised pancreas showed multiple cysts located in the branch pancreatic duct with a maximum diameter of 75 mm. The mural nodule had a maximum diameter of 25 mm. The tumor was diagnosed as an IPMA by pathological examination. After operation, the patient was discharged without any complications. Two years after resection, the patient remains in remission with no evidence of tumor recurrence.
Highlights
Detection of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas has been increasing due to recent advances in imaging
Magnetic resonance cholangiopancreatography (MRCP) revealed a cystic lesion located in the pancreatic head (Figure 1A,B) with a mural nodule (Figure 1C), seen as a slight increase in intensity
Recent guidelines [2] recommended that surgical resection should be considered without further testing if a patient with a cystic lesion of the pancreas has obstructive jaundice, an enhancing solid component within the cyst, or dilation of the main pancreatic duct (MPD) to ≥10 mm
Summary
Detection of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas has been increasing due to recent advances in imaging. Magnetic resonance cholangiopancreatography (MRCP) revealed a cystic lesion located in the pancreatic head (Figure 1A,B) with a mural nodule (Figure 1C), seen as a slight increase in intensity. The mural nodule had papillary growth with a diameter of 18 mm (Figure 3A), and the MPD was slightly dilated to 6 mm (Figure 3B). Pathological examination revealed a composition of papillary structures consisting of pancreatobiliary-type mucincontaining columnar epithelial cells with low-grade atypia (Figure 4B,C,D). These tumor cells were negative for p53 on immunohistochemistry. The patient remains in remission with no evidence of tumor recurrence
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