Intraductal papillary mucinous neoplasm in a 26 year old lady: a diagnostic therapeutic challenge!
Keywords:Papillary, Mucinous, Radiology, Surveillance, Branched duct, Worrisome
Intraductal papillary mucinous neoplasm of the pancreas is a mucin producing cystic mass which originates from the pancreatic duct first defined by Ohashi et al in 1982. World Health Organization (WHO) classified mucin-producing cystic neoplasms of pancreas into 2 groups: mucinous cystic neoplasm and IPMNs. IPMN is a difficult diagnosis. Many patients may be asymptomatic for as long as 1 year and few show vague symptoms. Due to advances in radiology the incidental detection of IMPNs have increased. A 26 years old lady presented with vague pain in abdomen since 1 month with an incidental USG (A+P) finding of a cystic avascular lesion between the head and body of pancreas. CECT (A+P) and MRCP confirmed the diagnosis of branched duct IPMN with worrisome (cyst size >3 cm). Suggestive of branched duct IPMN with worrisome (cyst size >3 cm) considering the age of the patient, size of the cyst and worrisome features patient was posted for excision cyst. The tumour was well circumscribed arising from branched duct with communication with the main duct. Tumour was resected well. Histopathology revealed a benign cystic neoplasm of pancreas s/o IPMN with no e/o malignancy. In younger age group it is better to resect the tumour than timely surveillance as longer life expectancy in them provides an adequate time span for a low grade, branched duct tumour with worrisome features to undergo malignant transformation.
Dumlu EG, Karakoç D, Özdemir A. Intraductal Papillary Mucinous Neoplasm of the Pancreas: Current Perspectives. Int Surg. 2015;100(6):1060-8.
Tanaka M, Fernández-del Castillo C, Adsay V, Chari S, Falconi M, Jang JY et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. 2012;12(3):183-97.
Ohashi K, Murakami Y, Takekoshi T. Four cases of mucin producing cancer of the pancreas on specific findings of papilla of vater. Prog Diag Endosc. 1982;20:348-51.
Longnecker DS, Adler G, Hruban RH. Intraductal papillarymucinous neoplasms of the pancreas. In: Hamilton SR, AaltonenLA, eds. World Health Organization Classification of Tumors. Lyon, France: IARC Press. 2000;237-41.
Waters JA, Schnelldorfer T, Aguilar-Saavedra JR, Chen JH, Yiannoutsos CT, Lillemoe KD. Survival after resection for invasive intraductal papillary mucinous neoplasm and for pancreatic adenocarcinoma: a multi-institutional comparison according to American Joint Committee on cancer stage. J Am Coll Surg. 201;213(2):275-83.
Andrejevic-Blant S, Kosmahl M, Sipos B, Klöppel G. Pancreatic intraductal papillary-mucinous neoplasms: a new and evolving entity. Virchows Arch. 2007;451(5):863-9.
Lee KS, Sekhar A, Rofsky NM, Pedrosa I. Prevalence of incidental pancreatic cysts in the adult population on MR imaging. Am J Gastroenterol. 2010;105(9):2079-84.
Taouli B, Vilgrain V, O'Toole D, Vullierme MP, Terris B, Menu Y. Intraductal papillary mucinous tumors of the pancreas: features with multimodality imaging. J Comput Assist Tomogr. 2002;26(2):223-31.
Bloomgart’s surgery of liver, biliary tract and pancreas. 6th edition. 959-70.
D'Angelica M, Brennan MF, Suriawinata AA, Klimstra D, Conlon KC. Intraductal papillary mucinous neoplasms of the pancreas: an analysis of clinicopathologic features and outcome. Ann Surg. 2004;239(3):400-8.
Conlon KC. Intraductal papillary mucinous tumors of the pancreas. J Clin Oncol. 2005;23(20):4518-23.
TurriniO, Waters JA, Schnelldorfer T, Lillemoe KD, Yiannoutsos CT, Farnell MB. Invasive intraductal papillary mucinous neoplasm: predictors of survival and role of adjuvant therapy. HPB (Oxford). 2010;12(7):447-55.