[A case of non-invasive IPMC with fibrotic lesion-like "tubular complex"]
Yasuaki Abe1,2, Kenji Kimura1, Hiromune Shimamura3
1Department of Gastroenterology, National Hospital Organization Sendai Medical Center.
Insights
A rare case of non-invasive intraductal papillary mucinous carcinoma (IPMC) was diagnosed after initial misidentification as a benign neoplasm. Histopathology revealed a fibrotic lesion potentially causing pancreatic duct stenosis.
Area of Science:
- Gastroenterology
- Surgical Pathology
- Oncology
Background:
- Intraductal papillary mucinous neoplasms (IPMNs) are cystic pancreatic tumors with malignant potential.
- Accurate preoperative diagnosis of IPMN subtypes and invasiveness is crucial for treatment planning.
- Distinguishing benign IPMN from early-stage carcinoma can be challenging.
Abstract:
A 73-year-old man was incidentally diagnosed with a cystic lesion in the pancreatic body. Ultrasonography, abdominal computed tomography, magnetic resonance imaging, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasound were performed, and a nodule was detected in the cystic lesion along with an irregularity of the main pancreatic duct. An initial diagnosis of a mixed-type intraductal papillary mucinous neoplasm was made, and a central pancreatectomy was performed. However, the final diagnosis was altered to non-invasive intraductal papillary mucinous carcinoma (IPMC). The histopathological examination revealed a fibrotic lesion that was similar to "tubular complex" findings observed in mouse models of pancreatic cancer. The fibrotic lesion was placed between the main pancreatic duct lesion and branch-duct cystic lesion. The changes reflected in branch-level stenosis may be caused by IPMC growth.
