Intraductal Papillary Mucinous Adenocarcinoma Research Articles

A Case of Pancreaticoduodenectomy with Perioperative Administration of Activated Protein C Concentrate for Intraductal Papillary Mucinous Adenocarcinoma with Congenital Protein C Deficiency

A Case of Pancreaticoduodenectomy with Perioperative Administration of Activated Protein C Concentrate for Intraductal Papillary Mucinous Adenocarcinoma with Congenital Protein C Deficiency

A Case of Intraductal Papillary Mucinous Adenocarcinoma of the Pancreas with Rapid Progression to Rupture

A Case of Intraductal Papillary Mucinous Adenocarcinoma of the Pancreas with Rapid Progression to Rupture

A Case of Intraductal Papillary Mucinous Neoplasm-Derived Pancreatic Adenosquamous Cell Carcinoma in Residual Pancreas Five Years after Surgery for Intraductal Papillary Mucinous Adenocarcinoma

A Case of Intraductal Papillary Mucinous Neoplasm-Derived Pancreatic Adenosquamous Cell Carcinoma in Residual Pancreas Five Years after Surgery for Intraductal Papillary Mucinous Adenocarcinoma

12年の経過中に3回の手術を行ったIPMCの一例

12年の経過中に3回の手術を行ったIPMCの一例

Biliary tract intraductal papillary mucinous neoplasm: A brief report and review of literature

Biliary Tract Intraductal Papillary Mucinous Neoplasm (BT-IPMN) is a very rare entity, gradually emerging into attention as sporadic cases are being reported worldwide. In this brief report we discuss about such an entity from our part of the world, based on a case from our institution. A 47-year-old female was referred to our department with jaundice, intermittent fever with chills and rigor of 6 weeks duration. Initial evaluation revealed obstructive jaundice with distended gall bladder. Imaging with ultrasonogram (USG) and magnetic resonance imaging (MRI) showed hugely dilated intra and extrahepatic biliary radicles with multiple and diffuse soft tissue lesions filling the common bile duct (CBD) extending to the ductal system of left lobe of liver. A side viewing endoscopy demonstrated mucin extruding from a prominent ampulla of Vater. The patient was managed successfully by left hepatectomy with pancreaticoduodenectomy (HPD). Gross pathological examination of the specimen showed marked dilatation of intra and extra hepatic bile ducts with multiple polypoidal lesions and plenty of mucin filling the entire biliary ductal system. Histopathology revealed predominantly intraductal papillary mucinous adenocarcinoma at the hilum extending to left bile duct with diffuse dysplastic changes throughout the biliary tree. Thus the clinical, radiological and pathological features of this lesion clearly fit into the diagnosis of BT-IPMN, which is slowly being established as a definite clinical entity with features much similar to its pancreatic counterpart.

Laparoscopic Assisted Distal Pancreatectomy for a Patient With Main Duct Intraductal Papillary Mucinous Adenocarcinoma

A 59-year-old female was admitted to our institution for further examination of a cystic tumor measuring 4 cm in diameter in the body and tail of the pancreas that had been detected incidentally by a CT scan. Based on a preoperative diagnosis of non-invasive and localized main duct intraductal papillary mucinous carcinoma (IPMC) with further extensive imaging studies, we performed laparoscopic assisted distal pancreatectomy following careful pre- and intraoperative investigations. After the body and tail of the pancreas were mobilized from the retroperitoneum laparoscopically, the pancreas was transected using an ultrasonic dissector (CUSA) extracorporeally through a 6-cm upper-midline incision. During parenchymal transection of the pancreas, even small pancreatic ducts and vessels were exposed, tied and divided with the aid of CUSA. Postoperative histological study demonstrated an IPMC (pTis, pN0, M0, Stage 0). The patient recovered uneventfully and was discharged on the 12th postoperative day. In the present case, IPMC was successfully resected by a minimally invasive laparoscopy assisted surgery. This strategy can be a new optional treatment for a localized, non-invasive IPMC with accurate pre- and intraoperative diagnoses.

Cystic Lesion Mimicking Intraductal Papillary Mucinous Tumor Arising in Heterotopic Pancreas of the Stomach and Synchronous Intraductal Papillary Mucinous Adenocarcinoma of the Pancreas

This article presents the study of a 66-year-old man with an asymptomatic pancreatic mass detected incidentally 4 months earlier. A magnetic resonance imaging scan revealed 2 distinct cystic masses in the pancreas and the gastric antrum. Microscopically, the pancreatic lesion showed dilated cysts containing papillary structures lined by mucinous epithelium, which showed a loss of polarity, an increased nucleus-to-cytoplasm ratio, a prominent nucleolus, and high proliferation on immunostaining for Ki-67. The gastric lesion was composed of heterotopic pancreatic tissue surrounding a large dilated cyst that was lined with mucinous epithelium and contained a few intraluminal papillae.

腹腔鏡補助下膵体尾部切除術を施行した主膵管型膵管内乳頭粘液性腺癌の1例

59歳女性．直腸腫瘍による排便時出血を主訴に来院し，腹部CTで膵体尾部に4cmの嚢胞性腫瘍を認めた．精査の結果，主膵管型膵管内乳頭粘液性腺癌（intraductal papillary mucinous carcinoma,以下IPMC）と診断した．術前診断では腫瘍は膵体尾部に限局し，明らかな浸潤所見は認めなかった．術中所見でも浸潤癌の所見なく腹腔鏡補助下膵体尾部切除を施行した．腹腔鏡下に膵体尾部脾臓を後腹膜より剥離し，上腹部正中に6cmの皮切をおき小開腹にて体外へ誘導した．超音波外科吸引装置（CUSA）を用いて膵を切離，主膵管を結紮切離し，切除を終了した．術後病理でIPMC（pTis, pN0, M0, Stage 0）と最終診断し，術後第12日目に退院した．本症例ではCUSAを用いた膵実質切離手技を腹腔鏡補助下膵切除に応用し術後経過良好であった．IPMCに対しても詳細な術前·術中診断を行い，症例を選択すれば腹腔鏡を用いた低侵襲手術が可能と考えられた．

Intraductal papillary-mucinous adenocarcinoma in the remnant pancreas after pancreatoduodenectomy for cancer of Vater's papilla associated with intraductal papillary-mucinous adenoma

A 72-year-old woman, who had undergone pylorus-preserving pancreatoduodenectomy 3 years before for cancer of Vater's papilla associated with a branch-type intraductal papillary-mucinous adenoma (IPMA), developed dilatation of the main duct and a nodular lesion in the remnant pancreas. Total pancreatectomy was performed, which revealed that the lesion was intraductal papillary-mucinous adenocarcinoma (IPMC) with minimal invasion, suggesting the metachronous multicentric occurrence of this intraductal papillary-mucinous neoplasm (IPMN). Because there were no malignant cells at the pancreaticojejunostomy, and because the histological appearance of the main-duct IPMC was different from that of the IPMA in the primary specimen, the main-duct IPMC was thought to be of different origin from the IPMA. These findings suggest that careful surveillance of the gastrointestinal tract and careful follow up are necessary for IPMN, because an IPMN could be associated with other gastrointestinal tract malignancies.

Intraductal papillary mucinous neoplasms of the pancreas: an analysis of protein expression and clinical features

The molecular pathology of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas has not been well characterized, and there are no reliable markers to predict the presence of associated invasive carcinoma in patients with IPMNs. We investigated the clinicopathologic characteristics of 37 IPMNs and the immunohistochemical findings of these tumors to investigate the malignancy of IPMNs. Between May 1992 and September 2003, 37 patients with IPMNs, 24 with adenoma and 13 with carcinoma, underwent pancreatic resections at Sapporo Medical University Hospital, Japan. In tumor specimens from these patients, we immunohistochemically analyzed the expression of p53 protein, proliferating-cell nuclear antigen (PCNA), vascular endothelial growth factor (VEGF), matrix metalloproteinase-7 (MMP-7), and E-cadherin. Clinical features and follow-up after resection were recorded. Aberrant expression of the proteins examined was frequently observed. Namely, there were significant differences in the expression of MMP-7 according to clinicopathological characteristics. Positive expression of MMP-7 was found in all of nine patients with infiltrating ductal pancreatic adenocarcinoma (IDC) and in all of seven patients with invasive intraductal papillary mucinous adenocarcinoma (IC-IPMC); however, 33.3% of patients with noninvasive IPMA, 58.3% of patients with intraductal papillary mucinous adenoma (IPMA), and all normal pancreatic tissues were negative for MMP-7; differences which were statistically significant (P < 0.05). Our current results indicate that MMP-7 may play a significant role in the progression of noninvasive to invasive IPMC.

Intraductal papillary mucinous adenocarcinoma of the bile ducts

Intraductal papillary mucinous adenocarcinoma of the bile ducts

A Multicentric Development Of Intraductal Papillary Mucinous Neoplasm Treated By Repeated Pancreatectomy

There are few reports of multicentric recurrence after resection of lesions of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas. We report a case of repeated pancreatectomy for recurrent IPMN showing multicentric development in the pancreatic remnant after resection of the initial lesion. In February 1999 a 70-year-old man underwent distal pancreatectomy for a cystic neoplasm in the pancreatic tail. Histological examination revealed invasive intraductal papillary mucinous adenocarcinoma (IPMC) with lymph node metastasis. Forty-seven months later, a cystic mass with an intracystic nodule was detected during surveillance by computed tomography. The patient underwent completion pancreatectomy. Histological examination demonstrated IPMC with neural invasion. In immunohistochemical staining, the initial specimen was positive for proteinase-activated receptor 2, but the second specimen was not. The present case helps elucidate the multicentric development of IPMN of the pancreas. We recommend careful surveillance for the recurrence of IPMN in the pancreatic remnant after resection.

Successful Preoperative Diagnosis and Complete Resection of Biliary Intraductal Papillary-Mucinous Neoplasm of the Liver

CASE REPORT A 59-year-old man was admitted to our hospital for further examination of an asymptomatic cystic tumor in the liver. On admission, he was not jaundiced, and the mass was not palpable in his abdomen. Laboratory evaluation did not demonstrate any abnormalities. Serum carcinoembryonic antigen level was within the normal range, but the carbohydrate antigen 19-9 level was elevated at 221 U/ml (normal range 3 to 25 U/ml). Abdominal ultrasonography and CT demonstrated a multilocular cystic tumor in the left lobe of the liver measuring 5 cm without mural nodules (Fig. 1). Endoscopic retrograde cholangiography showed a widely opened Vater’s ampulla and dilated common bile duct measuring 25 mm with filling defects containing mucus. The left hepatic and intrahepatic bile ducts in the left hepatic lobe were not visualized. No apparent communication was present between the cystic tumor and the bile ducts. Cytology of the biliary juice was examined three times, and diagnosed as showing borderline malignancy. Under a diagnosis of biliary intraductal papillarymucinous neoplasm localized in the left lobe of the liver with possible malignant transformation, left hemihepatectomy with lymphadenectomy in the hepatoduodenal ligament was performed. The resected specimen macroscopically showed multiple saccular dilatations of the intrahepatic biliary tree containing mucous fluid in the left lobe of the liver (Fig. 2). Subsequent pathological examination demonstrated that the tumor was a biliary intraductal papillarymucinous adenocarcinoma. The internal surface of the dilated biliary tree consisted of high columnar epithelium with mucin-producing cells and a partly

Diagnosing Pancreatic Cancer Using Methylation Specific PCR Analysis

The aim of this study was to determine the utility of detecting methylated ppENK and p16 in pancreatic juice by methylation specific PCR as a marker of pancreatic adenocarcinoma. Pancreatic juice samples were collected either intraoperatively, from 92 patients undergoing pancreaticoduodenectomy for benign (n = 20) and malignant periampullary disease (n = 72) or endoscopically (by duodenal aspiration after secretin infusion), from 13 patients undergoing investigation for pancreatic disease. Methylated ppENK was detected in the pancreatic juice of 30 (66.7%) of 45 patients with pancreatic ductal adenocarcinoma, in 4 (44.4%) of 9 patients with intraductal papillary-mucinous adenocarcinoma, and in 7 (41.2%) of 17 patients with other periampullary carcinomas, using methylation specific PCR. Methylated p16 was detected in a lower percentage of these patients (11.1%, 11.1% and 23.5%, respectively). In contrast, methylated ppENK and p16 were not detected in 21 patients with non-malignant disease including 12 patients with chronic pancreatitis. Methylated ppENK was detected in 30 of 33 (90.9%) primary pancreatic adenocarcinoma and methylated p16 was in 6/33 (18.2%). Despite the absence of ppENK and p16 methylation in normal pancreas, methylated ppENK and p16 was present in the duodenum of 90.5% and 28.6%, respectively of patients without cancer. Further, methylated ppENK and p16 was seen in 88.9% and 11.1%, respectively of pancreatic juice samples obtained by duodenal aspiration from patients without cancer. We conclude that since ppENK and p16 are not normally methylated in pancreatic secretions, detection of methylated ppENK and p16 in pure pancreatic juice obtained by direct cannulation of the pancreatic duct to avoid duodenal secretions may suggest the presence of pancreatic adenocarcinoma Key Words: Pancreatic juice, Methylation, ppENK, Pancreatic adenocarcinoma

Long-term surgical outcome of noninvasive and minimally invasive intraductal papillary mucinous adenocarcinoma of the pancreas.

The objective of this study was to clarify the long-term outcome after surgical resection in patients with noninvasive and minimally invasive intraductal papillary mucinous adenocarcinoma. We performed a retrospective review of the clinicopathological features and outcome in patients who underwent pancreatic resection for noninvasive and minimally invasive intraductal papillary mucinous adenocarcinoma between November 1982 and December 1997 at Chiba University Hospital. Minimally invasive structures were pathologically observed in five cases. The mean age of patients with either noninvasive (n = 16) or minimally invasive n = 5) adenocarcinoma was 61 years. Of the patients with minimally invasive adenocarcinoma, 4 had abdominal pain. Conversely, 7 patients with noninvasive adenocarcinoma had no complaint. The mean size of noninvasive and minimally invasive tumors was 2.5 cm (range 0.8 to 4.0) and 3.3 cm (range 2.5 to 4.5), respectively. The overall 5-year and 10-year survival rates for all 21 patients were 89% and 47%, respectively. Disease recurred in 3 patients; 2 patients with minimally invasive adenocarcinoma and 1 with noninvasive adenocarcinoma. Recurrence sites were peritoneum = 2) and main pancreatic duct of the remnant pancreas (n = 1); 5 disease-free patients died of unrelated causes. The remaining 13 patients are alive and disease free 3 to 12 years after surgery. Noninvasive and minimally invasive intraductal papillary mucinous adenocarcinoma had a favorable prognosis after surgical treatment.