[A Case of Invasive Intraductal Papillary Mucinous Neoplasm(IPMN)Where Determining the Intraoperative Resection...

Area of Science:

• Gastroenterology
• Surgical Oncology
• Diagnostic Imaging

Background:

• Intraductal papillary mucinous neoplasms (IPMN) are premalignant pancreatic cystic lesions.
• Progression from IPMN to invasive pancreatic ductal adenocarcinoma (IPMC) poses a significant clinical challenge.
• Accurate preoperative diagnosis of IPMN and its malignant potential is critical for patient management.

Purpose of the Study:

• To report a case of a 75-year-old man with a 4-mm branch-duct IPMN that progressed to invasive IPMC.
• To illustrate the diagnostic challenges associated with IPMN progression.
• To review the literature on IPMN and invasive IPMC.

Main Methods:

• A 75-year-old male patient with a known IPMN was monitored over 3.5 years.
• Diagnostic modalities included endoscopic ultrasound (EUS), contrast-enhanced CT, ERCP, and MRCP.
• Fine-needle aspiration (FNA) and subsequent distal pancreatectomy with lymph node dissection were performed.
• Histopathological examination confirmed IPMN with an invasive component (IPMC).

Main Results:

• Initial 4-mm branch-duct IPMN progressed to an 81-mm IPMN with a 5-mm invasive IPMC.
• Imaging revealed main pancreatic duct dilation and a hypoechoic mass with irregular margins.
• FNA suggested atypical glands, and surgery confirmed invasive IPMC.
• The patient remained recurrence-free 3 years and 4 months postoperatively.

Conclusions:

• This case emphasizes the challenges in preoperative diagnosis of IPMN progression to invasive IPMC.
• Recurrence is a significant concern when IPMN transforms into invasive IPMC.
• Multimodality imaging and tissue sampling are essential for accurate IPMN assessment.