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• W2977311386 abstract "Introduction: Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is an increasingly diagnosed neoplasm that rarely penetrates adjacent organs. We report a rare case of IPMN with a focus of adenocarcinoma penetrating to 3 adjacent structures, treated by an extensive surgical resection with an excellent long term outcome. Case report: 60 year old asymptomatic male seen for evaluation of iron deficiency anemia. Colonoscopy one year prior showed no abnormalities. Esophagogastroduodenoscopy (EGD) showed an exophytic friable, soft papillary growth in the duodenal bulb arising from and completely occluding a diverticulum with copious amount of mucin. Biopsies from the duodenal growth showed adenoma with high grade dysplasia with positive mucin stains. Computed tomography (CT) showed an enlarged pancreas with numerous focal irregularities with an ill-defined mass. EUS showed a complex cystic mass with mixed hypoechoic cystic and solid components and mural nodules diffusely involving the pancreas. Surgery was recommended, but he refused and opted to do nothing. One year later he returned with abdominal pain, nausea and jaundice. MRI of the abdomen demonstrated enlarged pancreatic mass with a markedly dilated pancreatic duct which communicated with the distal part of the dilated common bile duct (CBD). Endoscopic Retrograde Cholangiopancreaticogram (ERCP) showed two fistulas at the antrum with mucinous discharge, a large mass at the duodenal bulb with mucin drainage, and a dilated CBD. A temporary biliary stent was placed and patient was referred for surgery where he underwent resection of spleen, pancreas, gallbladder and the distal stomach as well as portal vein reconstruction. Surgical pathology showed an invasive, moderately differentiated adenocarcinoma, arising from an IPMN, stage IIa (pT3N0M0). Repeat EGD's and CT scans of abdomen at 1 and 3 years showed post-operative anatomy with no tumor recurrence. Discussion: Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is usually benign but potentially malignant epithelial neoplasm that arises from mucin producing cuboidal cells in the pancreatic ducts. IPMNs may rarely rupture and penetrate adjacent organs, but in this case penetrated the duodenum, stomach and the common bile duct causing a large pancreaticobiliary fistula and obstructive jaundice. Our patient had a favorable outcome with no evidence of disease recurrence at 3 years following an extensive surgical resection of the tumor.Figure 1Figure 2Figure 3" @default.
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• W2977311386 date "2015-10-01" @default.
• W2977311386 modified "2023-10-16" @default.
• W2977311386 title "Intraductal Papillary Mucinous Neoplasm Penetrating Three Adjacent Organs" @default.
• W2977311386 doi "https://doi.org/10.14309/00000434-201510001-00158" @default.
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