Intraductal Oncocytic Papillary Neoplasm of the Pancreas with Celiac Artery Compression Syndrome and a Jejunal Artery Aneurysm: Report of a Case

Abstract

A 79-year-old woman presented with epigastralgia, and computed tomography showed a 3-cm multiloculated mass with a mural nodule in the head of the pancreas. Arteriography showed stenosis of the celiac artery and a saccular aneurysm, arising from the first jejunal artery. We made a preoperative diagnosis of intraductal papillary adenocarcinoma of the pancreatic head and performed a laparotomy. Transection of the median arcuate ligament failed to restore adequate hepatic blood flow, necessitating construction of celiac vascularization, achieved by a gastroduodenal to jejunal artery anastomosis. After ligation of the jejunal artery aneurysm, we performed a pylorus-preserving pancreaticoduodenectomy. Microscopically, the tumor had papillary intracystic growth, and was lined by plump cells with abundant eosinophilic cytoplasm, consistent with a diagnosis of intraductal oncocytic papillary neoplasm. We discuss this recently recognized entity of papillary neoplasm of the pancreas, and the importance of managing hepatic blood flow during pancreaticoduodenectomy in celiac artery compression syndrome.