scholarly journals Utility of endoscopic transpapillary pancreatic cyst drainage for intraductal papillary mucinous neoplasm infection

2021 ◽  
Vol 14 (6) ◽  
pp. e242583
Author(s):  
Shunsuke Watanabe ◽  
Masao Toki ◽  
Junji Shibahara ◽  
Tadakazu Hisamatsu
Keyword(s):  
Intraductal Papillary Mucinous Neoplasm ◽  
Cyst Wall ◽  
Pancreatic Cyst ◽  
Epigastric Pain ◽  
Drainage Tube ◽  
Endoscopic Drainage ◽  
Endoscopic Retrograde Pancreatography ◽  
Endoscopic Retrograde ◽  
Mucinous Neoplasm ◽  
Route Of Infection

A 61-year-old woman with intraductal papillary mucinous neoplasm (IPMN) infection, who was treated with antibiotics, developed IPMN reinfection with febrile epigastric pain and was febrile. CT showed that the diameter of the IPMN had grown and hardened, with thickening of the cyst wall. Endoscopic retrograde pancreatography was then performed and a nasopancreatic cyst drainage tube was placed into the cyst. Symptoms and inflammatory findings improved considerably 17 days after endoscopic drainage. Few reports and evidence have been found regarding IPMN infections, and the frequency of onset, route of infection and optimal drainage method remain unknown. This study indicated that endoscopic transpapillary pancreatic cyst drainage was effective and is highly recommended for IPMN infection.

A Case of Serous Cystadenoma Communicating with a Stenotic Santorini’s Duct and a Dilated Main Pancreatic Duct

2016 ◽  
Vol 25 (4) ◽  
pp. 551-554
Author(s):  
Hiroyuki Matsubayashi ◽  
Yurika Oka ◽  
Takaaki Ito ◽  
Katsuhiko Uesaka ◽  
Keiko Sasaki ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Endoscopic Ultrasonography ◽  
Intraductal Papillary Mucinous Neoplasm ◽  
Main Pancreatic Duct ◽  
Serous Cystadenoma ◽  
Endoscopic Retrograde Pancreatography ◽  
Endoscopic Retrograde ◽  
Cystic Neoplasms ◽  
Pancreas Head ◽  
Mucinous Neoplasm

A 59-year-old woman was referred for investigation of a pancreatic cystic lesion. Computed tomography revealed a well-demarcated, multilocular cyst, approximately 4 cm in size, at the pancreas head. Endoscopic ultrasonography demonstrated honeycomb-like components at the cyst margin. The cyst was associated with a widely-dilated upstream main pancreatic duct (MPD). Endoscopic retrograde pancreatography demonstrated a communication between the stenotic Santorini‘s duct and the cyst. Aspiration cytology from the cyst demonstrated clusters of mucinous epithelial neoplasm cells. Branch-type intraductal papillary mucinous neoplasm, possibly invading to the MPD, was suspected and pancreatoduodenectomy was performed. Surprisingly, pathology of the resected pancreas showed mixed-type serous cystadenoma. Abbreviations: CA19-9: cancer antigen 19-9; CEA: carcinoembryonic antigen; ERC: endoscopic retrograde cholangiography; ENPD: endoscopic naso-pancreatic drainage ; ERP: endoscopic retrograde pancreatography; EUS: endoscopic ultrasonography; NET: neuroendocrine tumor; FNA: fine needle aspiration; IPMN: intraductal papillary mucinous neoplasm; MRCP: magnetic resonance cholangiopancreatography; MPD: main pancreatic duct; SCA: serous cystic neoplasms.

Cytology from endoscopic retrograde cholangiopancreatography in the evaluation of invasive pancreatic head intraductal papillary mucinous neoplasm: A necessity?

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 266-266
Author(s):  
Alexandra M Roch ◽  
Michael Garrett House ◽  
Neil R Sharma ◽  
Jessica L Cioffi ◽  
John M DeWitt ◽  
...  
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Cancer Detection ◽  
Intraductal Papillary Mucinous Neoplasm ◽  
Pancreatic Head ◽  
Needle Aspiration ◽  
Endoscopic Retrograde ◽  
Biliary Endoprosthesis ◽  
Mucinous Neoplasm ◽  
Invasive Ipmn ◽  
Fluid Sampling

266 Background: Endoscopic retrograde cholangiopancreatography (ERCP) with brushing/fluid sampling has historically been the standard to establish invasive transformation of pancreatic head intraductal papillary mucinous neoplasm (IPMN). More recently, endoscopic ultrasound (EUS) with fine needle aspiration (FNA) has been employed for this purpose. We hypothesized that for patients with invasive IPMN, in the era of EUS FNA, there is no additional benefit of ERCP brushing/fluid sampling. Methods: A retrospective review of a prospectively maintained database of patients who underwent surgical resection for IPMN at a single academic center (1992-2014) was performed. Patients with invasive pancreatic head IPMN on surgical pathology were included. Cytopathology was considered positive if it showed adenocarcinoma or markedly atypical cells. Results: Of the 74 patients with invasive IPMN, 55 had a pancreatic head neoplasm. Preoperatively, 4 patients had neither EUS nor ERCP, 27 had only 1 endoscopic study (ERCP n=16, EUS n=11), and 24 had both EUS and ERCP. In 11 patients with EUS, 8 had positive FNA (73% sensitivity for cancer detection). In 16 patients with ERCP (brushing n=7, fluid n=9), 5 had positive cytology resulting in 31% sensitivity. Further analysis revealed 29% and 33% sensitivity for brushing and fluid sampling, respectively. When both procedures were performed (n=24; EUS+ERCP fluid n=10, EUS+ERCP brushing n=14), the sensitivity was 75%, but ERCP cytology changed the diagnosis in only 2 patients. EUS FNA was performed regardless of ERCP cytology results in 18 patients (after brushing n=6, after fluid sampling n=4, same day n=8; median interval=4 days). 6 patients had negative cytology from both EUS and ERCP. Conclusions: In patients with invasive pancreatic head IPMN, sensitivity of ERCP cytology for cancer detection was poor (31%), making an impact on diagnosis in only 2/55 patients. EUS FNA was performed in 75% patients regardless of ERCP cytology results. Aside from the therapeutic impact of ERCP (biliary endoprosthesis in jaundiced patients), its cytological role is limited, resulting in unnecessary and potentially avoidable cost.

scholarly journals A mixed-type intraductal papillary mucinous neoplasm of the pancreas with a histologic combination of gastric and pancreatobiliary subtypes in a 70-year-old woman: a case report

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Sawsan Ismail ◽  
Rama Darwisho ◽  
Mohammed Ali ◽  
Maen Haidar ◽  
Mohammad Adib Houreih ◽  
...  
Keyword(s):  
Histological Examination ◽  
Intraductal Papillary Mucinous Neoplasm ◽  
Mixed Type ◽  
Epigastric Pain ◽  
The Body ◽  
Diagnostic Methods ◽  
Pancreatic Ducts ◽  
Intraductal Papillary Mucinous Neoplasms ◽  
Mucinous Neoplasm ◽  
Mucinous Neoplasms

Abstract Background Intraductal papillary mucinous neoplasms are rare papillary pancreatic neoplasms arising from major pancreatic ducts, characterized by duct dilation and mucin secretion. They comprise approximately 1% of all exocrine neoplasms and are classified according to their anatomical sites into main duct-type, branch duct-type, and mixed-type intraductal papillary mucinous neoplasms. Histological examination plays a crucial role in distinguishing and classifying intraductal papillary mucinous neoplasms into gastric, intestinal, pancreatobiliary, and oncocytic subtypes. Case presentation We present the case of a 70-year-old Syrian woman who was admitted to our hospital due to an intermittent epigastric pain accompanied by diarrhea and weight loss with a recent diagnosis of diabetes mellitus. Following clinical, laboratory, and radiological examination, distal pancreatectomy involving the body and the tail of the pancreas was performed. Interestingly, histological examination of the resected specimens revealed the diagnosis of a mixed-type intraductal papillary mucinous neoplasm with a unique combination of gastric and pancreatobiliary subtypes. Conclusion To the best of our knowledge, the combination of multiple histological subtypes of intraductal papillary mucinous neoplasms has been recorded in a few studies with reference to the challenging histological detection. Herein, we report a rare case with a significant histological combination, highlighting the difficulties in differential diagnosis due to the absence of ancillary techniques, with a brief review on diagnostic methods, histological characteristics and surgical recommendations.

scholarly journals Total Pancreatectomy for Malignant Intraductal Papillary Mucinous Neoplasm (IPMN) Complicated by Gastropancreatic Fistulae

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Oshan Basnayake ◽  
Pradeep Wijerathne ◽  
Umesh Jayarajah ◽  
Nilesh Fernandopulle ◽  
Sivasuriya Sivaganesh
Keyword(s):  
Intraductal Papillary Mucinous Neoplasm ◽  
Total Pancreatectomy ◽  
Epigastric Pain ◽  
Past History ◽  
Ductal Adenocarcinoma ◽  
Fistula Formation ◽  
Oral Contrast ◽  
High Grade ◽  
Recurrent Acute Pancreatitis ◽  
Mucinous Neoplasm

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 total pancreatectomy, distal gastrectomy, and splenectomy were performed, and recovery was uneventful. Histology revealed a ductal adenocarcinoma arising from an intestinal type intraductal papillary mucinous neoplasm with high-grade dysplasia. A year and a half after surgery, she is healthy with good glycaemic control and nutritional status. Conclusion. This case highlights the importance investigating patients for the aetiology in recurrent acute pancreatitis and their follow-up. Awareness of cystic pancreatic neoplasms including IPMN is important to avoid misdiagnosis or delayed diagnosis. Referral of these patients to centres with facilities for multidisciplinary input and specialised management is strongly recommended.

scholarly journals The Diagnosis of Pancreatic Cyst by Endoscopic Retrograde Pancreatography and Ultrasonic Scanning

1977 ◽  
Vol 185 (3) ◽  
pp. 286-289 ◽  
Author(s):  
BENT NYBOE ANDERSEN ◽  
SOREN HANCKE ◽  
SVEND AAGE DAMGAARD NIELSEN ◽  
ARNE SCHMIDT
Keyword(s):  
Pancreatic Cyst ◽  
Endoscopic Retrograde Pancreatography ◽  
Endoscopic Retrograde ◽  
Ultrasonic Scanning
Sign in / Sign up

Export Citation Format

Share Document