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.

Adenosquamous cell carcinoma derived from intraductal papillary mucinous neoplasm of the pancreas confirmed by genetic analysis.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 275-275
Author(s):  
Hidenori Karasaki ◽  
Toru Kono ◽  
Yusuke Ono ◽  
Taku Maejima ◽  
Yusuke Mizukami
Keyword(s):  
Pancreatic Cancer ◽  
Cell Carcinoma ◽  
Intraductal Papillary Mucinous Neoplasm ◽  
De Novo ◽  
Epigastric Pain ◽  
Ductal Adenocarcinoma ◽  
Invasive Squamous Cell Carcinoma ◽  
Current Case ◽  
Mucinous Neoplasm ◽  
Poorly Differentiated

275 Background: Adenosquamous cell carcinoma (ASC) is an uncommon histologic variant of pancreatic cancer, representing only 1-4 % of all pancreatic neoplasms. Here we reported the extremely rare case of ASC derived from intraductal papillary mucinous neoplasm (IPMN) of the pancreas with intensive pathological and molecular analysis. Methods: A 72-year-old diabetic male with five-year history of non-alcoholic chronic pancreatitis was admitted to our hospital with complaint of epigastric pain. The patient was diagnosed as pancreatic cancer associated with IPMN and pylorus preserving pancreaticoduodenectomy was performed in April 2012. The resected pancreas was fixed in 10% formaldehyde, and the whole specimen was sliced at a thickness of 5-mm for i) pathological analyses using hematoxylin-eosin (H-E) staining and immunostaining with specific antibodies against MUC-1, -2, -5AC, -6, p63 and CD5/6, and ii) deep sequencing of multiplex PCR amplicons of 50 cancer-associated genes utilizing Ion Torrent PGM platform. DNA was obtained from intraepithelial lesions of IPMN, invasive squamous cell carcinoma (SCC) and adenocarcinoma (AC) after enrichment for neoplastic cellularity, using manual microdissection. Results: Pathological findings showed IPMN extended from main pancreatic duct to branch ducts. The invasive tumor was predominantly consisted of poorly-differentiated SCC and small poorly-differentiated AC was also found in the edge of the SCC. All IPMN area analyzed shared combination of the mutations, KRASG12D and GNASR201C. The identical mutations in KRAS and GNAS as IPMNs were also found in SCC and AC. Conclusions: It generally difficult to fully discriminate IPMN-derived cancer (invasive IPMN) from concomitantly and independently developed de novo pancreatic ductal adenocarcinoma (PDA) originating from the “field defect”. In the current case, although SCC is a rare histotype of IPMNs, we considered that the invasive carcinoma was derived from IPMN based on their mutational profile.

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.

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