Intraductal Papillary Mucinous Neoplasm Presenting as Bleeding Duodenal Mass: A Surgical Rarity (original) (raw)
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Case Reports in Surgery
Background. Intraductal papillary mucinous neoplasms (IPMN) of the pancreas complicated by fistula formation to adjacent organs are an uncommon phenomenon. We present an IPMN of the pancreas with malignant transformation and multiple fistulae to the stomach and duodenum. Case Presentation. A 50-year-old female was referred for investigation of recent epigastric pain and a past history of recurrent pancreatitis. Imaging with computed tomography showed a gross dilatation of the entire pancreatic duct with a heterogeneous enhancement of the periductal parenchyma. A passage of oral contrast was noted from the greater curvature and pylorus of the stomach into the dilated duct suggestive of fistulae formation. Gastroduodenoscopy demonstrated these fistulae in the stomach and the proximal duodenum and an exophytic growth at the ampulla obliterating the view of ampullary opening. Endosonography- (EUS-) guided fine-needle aspiration cytology (FNAC) showed cells with high-grade atypia. A tota...
Gut, 2011
Abbreviations: BT, branch duct-type intraductal papillary mucinous neoplasms; GAS, gastric-type intraductal papillary mucinous neoplasms; INT, intestinal-type intraductal papillary mucinous Furukawa et al. 3 neoplasms; IPMA/B, intraductal papillary mucinous neoplasm with low-grade or moderate dysplasia, adenoma, or borderline; IPMC, intraductal papillary mucinous neoplasm with high-grade dysplasia or noninvasive carcinoma; IPMC-MIN, intraductal papillary mucinous neoplasm with minimal invasion; IPMC-INVC, intraductal papillary mucinous neoplasm with an associated invasive colloid carcinoma; IPMC-INVO, intraductal papillary mucinous neoplasm with an associated invasive oncocytic carcinoma; IPMC-INVT, intraductal papillary mucinous neoplasm with an associated invasive tubular carcinoma; IPMN, intraductal papillary mucinous neoplasm; MT, main duct-type intraductal papillary mucinous neoplasms; MUC1, mucin 1; MUC2, mucin 2; MUC5AC, mucin 5AC; MX, mixed type intraductal papillary mucinous neoplasms; ONC, oncocytic-type intraductal papillary mucinous neoplasms; PB, pancreatobiliary-type intraductal papillary mucinous neoplasms; Furukawa et al. 4 Abstract Objective:
Diagnostic pathology, 2010
A 60-year-old Caucasian male underwent a total pancreatectomy for a mixed type pancreatic intraductal papillary mucinous neoplasm (IPMN) arising in the main and secondary pancreatic ducts. During surgery, a subserosal polypoid mass was noted at the greater curvature of the gastric antrum and was enucleated. This mass was proven to be heterotopic pancreatic tissue with cystic neoplasia of the IPMN histologic subtype. Through an extensive search of the literature, we found that this is the first case ever reported with simultaneous existence of IPMN changes, in the main and secondary ducts of the orthotopic pancreas and in the heterotopic pancreatic tissue of the gastric wall.
World journal of surgical oncology, 2005
Fistula formation has been reported in intraductal papillary-mucinous neoplasms (IPMNs) with or without invasion of the adjacent organs. The presence or absence of invasion is mostly determined by postoperative histological examination rather than by preoperative work-up. A 72 year-old Japanese woman showed remarkable dilatation of the main pancreatic duct (MPD) in the distal region of the pancreas. Subsequent ERCP also showed MPD dilatation, after which the patient suffered moderate pancreatitis. A subsequent gastroscopy revealed a small ulceration that had not been observed in a gastroscopy performed 3 months prior. Mucinous discharge from the ulceration suggested it might be the orifice of a fistula connected to the MPD. En bloc resection including the distal region of the pancreas, spleen, stomach and part of the transverse colon was performed under the pre- and intraoperative diagnosis of an invasive malignant IPMN. However, histopathology revealed the lesion to be of "bor...
Intraductal papillary mucinous tumors of the pancreas: biology, diagnosis, and treatment
Pancreatic intraductal papillary mucinous neoplasms (IPMNs) rank among the most common cystic tumors of the pancreas. For a long time they were misdiagnosed as mucinous cystadenocarcinoma, ductal adenocarcinoma in situ, or chronic pancreatitis. Only in recent years have IPMNs been fully recognized as clinical and pathological entities, although their origin and molecular pathogenesis remain poorly understood. IPMNs are precursors of invasive carcinomas. When resected in a preinvasive state patient prognosis is excellent, and even when they are already invasive, patient prognosis is more favorable than with ductal adenocarcinomas. Subdivision into macroscopic and microscopic subtypes facilitates further patient risk stratification and directly impacts treatment. There are main duct and branch duct IPMNs, with the main duct type including the intestinal, pancreatobiliary, and oncocytic types and the branch duct type solely harboring the gastric type. Whereas main duct IPMNs have a high risk for malignant progression, demanding their resection, branch duct IPMNs have a much lower risk for harboring malignancy. Patients with small branch duct/gastric-type IPMNs (<2 cm) without symptoms or mural nodules can be managed by periodic surveillance. The Oncologist 2010;