Introduction. Intraductal papillary mucinous neoplasms (IPMN) are among the
most common cystic neoplasms of the pancreas, but they represent only 1-3% of
all exocrine pancreas tumors. With the development of diagnostic
possibilities the number of patients with IPMN is constantly increasing and
represents approximately 20% of all surgically treated pancreatic tumors. The
development of laparoscopic surgery has led to advances in the treatment of
cystic tumors of the pancreas with the emergence of new surgical dilemma in
the choice of surgical techniques in patients with IPMN. Case Outline. A
23-year-old patient was admitted to the hospital with non-specific symptoms
of upper abdomen. Performed diagnostics indicated the existence of a tumor
formation at the periphery of the pancreas, in the region of the proximal
corpus, 8?5 cm in diameter. The cystic formation, wall thickness 3 mm, was
filled with dense contents and injected into the tissue of the pancreas, but
did not lead to an extension of the pancreatic duct. After adequate
preoperative preparation the patient was operated on, when a laparoscopic
enucleation of cystic tumor with coagulation and cutting off communication
between the peripheral pancreatic duct and pancreatic tumors was performed by
using ultrasound scissors. Histopathological analysis of the specimen
indicated an IPMN of the branch duct type (BD-IPMN) with a low grade
dysplasia. The line of resection was without cellular atypia.
Immunohistochemical analysis showed positivity on tumor mucins (MUC-5 and
MUC-2), which is typical for gastric type of BD-IPMN. Six months
postoperatively the patient showed no signs of recurrence of the disease.
Conclusion. Surgical treatment is the dominant choice for the treatment for
IPMN. Although minimally invasive, laparoscopic enucleation of BD-IPMN is
able to achieve an adequate level of radicality without the accompanying
complications and with short postoperative recovery period.
Intraductal tubular adenomas (pyloric gland-type) of the pancreas: clinicopathologic features are similar to gastric-type intraductal papillary mucinous neoplasms and different from intraductal tubulopapillary neoplasms