scholarly journals A case of intraductal tubulopapillary neoplasm of the pancreas in a branch duct: a rare case report and literature review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Atsushi Yamaguchi ◽  
Takuro Hamada ◽  
Kaoru Wada ◽  
Riho Moriuchi ◽  
Kanae Tao ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Case Reports ◽  
Pancreatic Head ◽  
Side Branch ◽  
World Health ◽  
Colonic Surgery ◽  
Branch Duct ◽  
Intraductal Tubulopapillary Neoplasm ◽  
Post Surgery

Abstract Background Intraductal tubulopapillary neoplasm (ITPN) of the pancreas is a new disease concept defined by the World Health Organization in 2010. ITPN progresses with tubulopapillary growth in the pancreatic duct and is known to have a fair prognosis. Localization in the main pancreatic duct (MPD) is one characteristic. There are few case reports of ITPN in a branch of the pancreatic duct (BD). Case presentation We encountered a case of ITPN localized in BD. An 85-year-old man was followed after colonic surgery for rectal carcinoma. An abdominal computed tomography scan revealed a cystic mass in the pancreatic head and further examination was done. A T2 weighted intension picture in magnetic resonance imaging showed a 20 mm cystic lesion with an internal mass of 15 mm. Duodenal papilla were slightly open and endoscopic retrograde pancreatography revealed mild and diffuse dilatation of the main pancreatic duct and mucin in the MPD. In consideration with the image examinations, we diagnosed the tumor as an intraductal papillary mucinous neoplasm with carcinoma because of its large mural nodule (> 10 mm in size) in a cyst. Consequently, a pancreaticoduodenectomy was performed. Macroscopically, a white solid tumor sized 2.5 × 1.8 × 1.0 was identified in the head of the pancreas. The cut surface of the resected pancreas showed a side-branch type intraductal tumor with tubulopapillary architecture without mucin secretion. Immunohistochemical staining was positive for MUC1, and negative for MUC2 and MUC5AC. The final diagnosis was determined to be pancreatic ITPN from BD. At the time of this report (48 months post-surgery), the patient remains disease-free without evidence of recurrence. Conclusion ITPNs localized in BD are rare and diagnosis prior to surgery is difficult. In our case, the shape was round, not papillary, and with little fluid. These characteristics are different from a branch duct type IPMN and can be a clue to suspect ITPN in BD.

Invasive Large Duct Type Pancreatic Adenocarcinoma: A Diagnostically Challenging Entity

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S63-S64
Author(s):  
M M Al-Attar ◽  
S M Khedr
Keyword(s):  
Pancreatic Duct ◽  
Pancreatic Adenocarcinoma ◽  
Main Pancreatic Duct ◽  
Correct Diagnosis ◽  
Pancreatic Head ◽  
Side Branch ◽  
Ductal Adenocarcinoma ◽  
Diagnostic Challenge ◽  
Invasive Adenocarcinoma ◽  
Non Invasive

Abstract Introduction/Objective Large duct type invasive pancreatic adenocarcinoma is a morphological variant of pancreatic ductal adenocarcinoma that poses a radiologic and pathologic diagnostic challenge as it closely mimics other non- invasive neoplasms, including mucinous cystic neoplasms and intraductal papillary mucinous neoplasms (IPMN). We report a case of large duct type invasive adenocarcinoma that on radiology closely mimics an IPMN. Methods/Case Report The case id that of a 73-year-old male presenting with weight loss and chronic diarrhea. Abdominal imaging revealed features suggestive of main duct IPMN with possible side branch extension into the pancreatic head. Endoscopic retrograde cholangiopancreatography showed a bile duct stricture that was stented and biopsied, revealing mucinous material with neoplastic cells. A Whipple procedure was performed, revealing a 3.3 cm, tank-pink, papillary lesion in the pancreatic head, that is partially cystic with mucinous contents, and displaying exophytic extension into the main pancreatic duct. Microscopically, the lesion consists of a high-grade IPMN involving the main pancreatic duct with side branch extension, and associated with invasive adenocarcinoma, the majority of which is of the large duct type, showing irregularly distributed large ducts with jagged edges and surrounding desmoplasia, with intra-luminal mucinous material and neutrophils. The lining cells show focal pseudo-stratification and bland cytology. Foci of conventional type invasive adenocarcinoma, clusters of invasive tumor cells, and peri-neural invasion are also identified. Post- procedure, the patient underwent chemotherapy with marked symptomatic improvement. Results (if a Case Study enter NA) NA Conclusion Large duct type invasive adenocarcinoma of the pancreas can closely mimic non-invasive pancreatic neoplasms, posing diagnostic challenges that require identification of subtle features to achieve the correct diagnosis and guide treatment.

Case 4.12

2014 ◽  
pp. 209-209
Author(s):  
Christine U. Lee ◽  
James F. Glockner
Keyword(s):  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Side Branch ◽  
Cystic Dilatation

71-year-old woman with a possible pseudocyst Anterior (Figure 4.12.1A) and posterior (Figure 4.12.1B) MIP images from 3D FRFSE MRCP reveal marked irregular cystic dilatation of the main pancreatic duct and dilatation of multiple side-branch ducts. IPMN involving the main pancreatic duct...

scholarly journals Intraductal papillary mucinous neoplasm of the pancreas. Personal series and synthetic review

2012 ◽  
Author(s):  
F. Gallucci ◽  
D. Avolio ◽  
R. De Ritis ◽  
L. Ferrara ◽  
U. Valentino ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Mixed Type ◽  
Pancreatic Tumors ◽  
Malignant Degeneration ◽  
Main Duct ◽  
Branch Duct ◽  
Asymptomatic Patients ◽  
Risk Of Malignancy ◽  
Tumor Types

Intraductal papillary mucinous neoplasms (IPMNs) are rare pancreatic tumors, accounting for less than 1-2% of all neoplasms of the pancreas. The main characteristic of IPMNs is their favorable prognosis, as these pre-malignant or malignant lesions are usually slow-growing tumors and radical surgery is frequently possible. According to the localization of the lesions, three different tumor types have been identified: the main-duct IPMN, the branch-duct IPMN and the mixed-type IPMN (involving both the main pancreatic duct and the side branches). IMPNs do not present pathognomonic signs or symptoms. The obstruction of the main pancreatic duct system may cause abdominal pain and acute pancreatitis (single or recurrent episodes). The tumor may be incidentally discovered in asymptomatic patients, particularly in those with branch-duct IPMNs. In clinical practice, any non-inflammatory cystic lesion of the pancreas should be considered as possible IPMN. Computed tomography, magnetic resonance imaging with cholangiopancreatography and endoscopic ultrasonography can localize an IPMN and assess its morphology and size. The choice between non-operative and surgical management depends on the risk of malignancy and on the definitive distinction between benign and malignant IPMNs. Main-duct IPMNs have a high risk of malignant degeneration, especially in older patients. The clinical and radiological features, as well as treatment and outcome, of eight patients with IPMN (five with main-duct, two with branch-duct and one with mixed-type) observed by the authors over the last ten years are presented.

Pancreatic head resection preserving the main pancreatic duct for congenital hyperinsulinism of infancy

2012 ◽  
Vol 28 (9) ◽  
pp. 935-937 ◽  
Author(s):  
Masayuki Obatake ◽  
Kyoko Mochizuki ◽  
Yasuaki Taura ◽  
Yukio Inamura ◽  
Akiko Nakatomi ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Pancreatic Head ◽  
Congenital Hyperinsulinism ◽  
Pancreatic Head Resection

scholarly journals Comparison Between Dunking (Invagination) Pancreaticojejunoanastomosis and Double Layer Duct to Mucosa Anastomosis After Cephalic Duodenopancreatectomy-Whipple Procedure for Pancreatic Cephalic Carcinoma

PRILOZI ◽  
2020 ◽  
Vol 41 (3) ◽  
pp. 39-47
Author(s):  
Aleksandar Shumkovski ◽  
Ljubomir Ognjenovic ◽  
Stojan Gjoshev
Keyword(s):  
Overall Survival ◽  
Pancreatic Fistula ◽  
Pancreatic Duct ◽  
Double Layer ◽  
Main Pancreatic Duct ◽  
Pancreatic Head ◽  
Postoperative Pancreatic Fistula ◽  
Postoperative Reflux ◽  
Soft Pancreas ◽  
Significant Difference

AbstractIntroduction: Pancreatic cancer is malignancy with poor prognosis for quality of life and overall survival. The incidence is variant, 7.7/100,000 in Europe, 7.6/100,000 in the USA, 2.2/100.000 in Africa. The only real benefit for cure is surgery, duodenopancreatectomy. The key points for this procedure are radicality, low morbidity and low mortality, the follow up and the expected overall survival. The benchmark of the procedure is the pancreaticojejunoanastomosis, with its main pitfall, postoperative pancreatic fistula B or C. Subsequently, the manner of creation of pancreaticojejunoanastomosis defines the safety, thus the postoperative morbidity and mortality. Finally, this issue remarkably depends on the surgeon and the surgical technique creating the anastomosis. We used 2 techniques with interrupted sutures, dunking anastomosis and duct-to-mucosa double layer technique. The objective of the study was to compare these 2 suturing techniques we applied, and the aim was to reveal the risk benefit rationale for dunking either duct to mucosa anastomosis.Material and method: In our last series of 25 patients suffering pancreatic head carcinoma we performed a standard dodenopancreatectomy. After the preoperative diagnosis and staging with US, CICT, tumor markers, they underwent surgery. Invagination-dunking anastomosis was performed in 15, whereas, duct-to-mucosa, double layer anastomosis was performed in 10. In the first group with dunking anastomosis, we had 6 patients with soft pancreas and 8 with narrow main pancreatic duct, less than 3 mm. In the duct-to-mucosa group there were 5 patients with soft pancreas and 4 with narrow main pancreatic duct. All other stages of surgery were unified, so the only difference in the procedure remained on the pancreatojejunoanastomosis. The onset of the postoperative pancreatic fistula was estimated with revelation of 3 fold serum level of alfa amylases from the third postoperative day in the drain liquid.Results: In the duct to mucosa group there wasn’t a clinically relevant postoperative pancreatic fistula, while in the dunking anastomosis group we had 4 postoperative pancreatic fistula B, 26 %. One of these 4 patients experienced intraabdominal collection – abscess, conservatively managed with lavation through the drain. Comparing the groups, there was no significant difference between the groups concerning the appearance of postoperative pancreatic fistula: p>0.05, p=0.125. From all 25 patients, in 21 patients biliary stent was installed preoperatively to resolve the preoperative jaundice. All 21 suffered preoperative and postoperative reflux cholangitis, extending the intra-hospital stay.Conclusion: So far, there have been many trials referring to opposite results while comparing these 2 techniques in creation of the pancreticojejunoanastomosis. In our study, the duct to mucosa anastomosis prevailed as a technique, proving its risk benefit rationale. However, further large randomized clinical studies have to be conducted to clarify which of these procedures would be the prime objective in the choice of the surgeon while creating pancreatojejunoanastomosis.

scholarly journals Intraductal papillary mucinous neoplasm complicated with intraductal bleeding in a young woman mimicked a cystic solid pseudo-papillary tumor: a case report

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jianman Wu ◽  
Yin Lin ◽  
Jingwen Wu
Keyword(s):  
Pancreatic Duct ◽  
Young Woman ◽  
Intraductal Papillary Mucinous Neoplasm ◽  
Main Pancreatic Duct ◽  
Pancreatic Head ◽  
Preoperative Imaging ◽  
Moderate Degree ◽  
Cystic Wall ◽  
Mucinous Neoplasm ◽  
Ct And Mri

Abstract Background There are only 6 cases of intraductal papillary mucinous neoplasm (IPMN) complicated with intraductal hemorrhage have been reported in English literatures. All these 6 cases of IPMN occurred in the old people. The present rare case of IPMN complicated with intraductal hemorrhage occurred in a young woman, and mimicked a cystic solid pseudo-papillary neoplasm (SPN) on preoperative imaging findings. Case presentation A 29-year-old young woman complained of a sustained mild right upper quadrant abdominal pain. CT and MRI showed a lobulated, partly ill-defined cystic lesion located in the pancreatic head. Spotted calcification within cystic wall was seen on CT. The lesion was demonstrated as predominantly homogeneous hyperattenuation on CT and homogeneous high signal without decreased signal on fat suppression sequence on T1WI. After contrast administration, the cystic wall and septa of lesion was showed gradually mild to moderate degree of enhancement over time both on CT and MRI. No communication between lesion and the main duct was found on MRCP and the main pancreatic duct and common bile duct were not dilated. Considering patient’s age, gender and manifestations of lesion on CT and MRI (calcification, bleeding and gradually enhanced pattern), the present case mimicked as a cystic SPN. The lesion was pathologically confirmed a branch type IPMN after surgical resection. Conclusion We propose that IPMN may need to be taken into account in the differential diagnosis when pancreatic cystic lesions occur in young women with bleeding, calcification, progressive enhancement of cystic wall and no communication with the main pancreatic duct.

scholarly journals Postoperative Complications of Beger Procedure

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Nayana Samejima Peternelli ◽  
Tali Wajsfeld ◽  
Felipe Henrique Yazawa Santos ◽  
Otavio Schmidt de Azevedo ◽  
Rodrigo Altenfelder Silva ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Conservative Treatment ◽  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Pancreatic Head ◽  
Unusual Complication ◽  
Refractory Pain ◽  
Beger Procedure ◽  
Pancreaticojejunal Anastomosis

Introduction. Chronic pancreatitis (CP) is considered an inflammatory disease that may cause varying degrees of pancreatic dysfunction. Conservative and surgical treatment options are available depending on dysfunction severity.Presentation of Case. A 36-year-old male with history of heavy alcohol consumption and diagnosed CP underwent a duodenal-preserving pancreatic head resection (DPPHR or Beger procedure) after conservative treatment failure. Refractory pain was reported on follow-up three months after surgery and postoperative imaging uncovered stones within the main pancreatic duct and intestinal dilation. The patient was subsequently subjected to another surgical procedure and intraoperative findings included protein plugs within the main pancreatic duct and pancreaticojejunal anastomosis stricture. A V-shaped enlargement and main pancreatic duct dilation in addition to the reconstruction of the previous pancreaticojejunal anastomosis were performed. The patient recovered with no further postoperative complications in the follow-up at an outpatient clinic.Discussion. Main duct and pancreaticojejunal strictures are an unusual complication of the Beger procedure but were identified intraoperatively as the cause of patient’s refractory pain and explained intraductal protein plugs accumulation.Conclusion. Patients that undergo Beger procedures should receive close outpatient clinical follow-up in order to guarantee postoperative conservative treatment success and therefore guarantee an early detection of postoperative complications.

Sign in / Sign up

Export Citation Format

Share Document