Concomitant pancreatic endocrine neoplasm and intraductal papillary mucinous neoplasm

A case report and literature review

Yoshie Kadota, Masahiro Shinoda, Minoru Tanabe, Hanako Tsujikawa, Akihisa Ueno, Yohei Masugi, Go Oshima, Ryo Nishiyama, Masayuki Tanaka, Kisho Mihara, Yuta Abe, Hiroshi Yagi, Minoru Kitago, Osamu Itano, Shigeyuki Kawachi, Koichi Aiura, Akihiro Tanimoto, Michiie Sakamaoto, Yuukou Kitagawa

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

We report a case of concomitant pancreatic endocrine neoplasm (PEN) and intraductal papillary mucinous neoplasm (IPMN). A 74-year-old man had been followed-up for mixed-type IPMN for 10 years. Recent magnetic resonance images revealed an increase in size of the branch duct IPMN in the pancreas head, while the dilation of the main pancreatic duct showed minimal change. Although contrast-enhanced computed tomography and magnetic resonance imaging did not reveal any nodules in the branch duct IPMN, endoscopic ultrasound indicated a suspected nodule in the IPMN. A malignancy in the branch duct IPMN was suspected and we performed pylorus-preserving pancreatoduodenectomy with lymphadenectomy. The resected specimen contained a cystic lesion, 10 x 10 mm in diameter, in the head of the pancreas. Histological examination revealed that the dilated main pancreatic duct and the branch ducts were composed of intraductal papillary mucinous adenoma with mild atypia. No evidence of carcinoma was detected in the specimen. Incidentally, a 3-mm nodule consisting of small neuroendocrine cells was found in the main pancreatic duct. The cells demonstrated positive staining for chromogranin A, synaptophysin, and glucagon but negative staining for insulin and somatostatin. Therefore, the 3-mm nodule was diagnosed as a PEN. Since the mitotic count per 10 high-power fields was less than 2 and the Ki-67 index was less than 2%, the PEN was pathologically classified as low-grade (G1) according to the 2010 World Health Organization (WHO) criteria. Herein, we review the case and relevant studies in the literature and discuss issues related to the synchronous occurrence of the relatively rare tumors, PEN and IPMN.

Original languageEnglish
Article number75
JournalWorld Journal of Surgical Oncology
Volume11
DOIs
Publication statusPublished - 2013 Mar 21

Fingerprint

Pancreatic Neoplasms
Pancreatic Ducts
Neoplasms
Chromogranin A
Negative Staining
Neuroendocrine Cells
Synaptophysin
Pancreaticoduodenectomy
Pylorus
Somatostatin
Lymph Node Excision
Glucagon
Adenoma
Dilatation
Pancreas
Magnetic Resonance Spectroscopy
Head
Tomography
Magnetic Resonance Imaging
Insulin

Keywords

  • Intraductal papillary mucinous neoplasm
  • Pancreatic endocrine neoplasm

ASJC Scopus subject areas

  • Oncology
  • Surgery

Cite this

Concomitant pancreatic endocrine neoplasm and intraductal papillary mucinous neoplasm : A case report and literature review. / Kadota, Yoshie; Shinoda, Masahiro; Tanabe, Minoru; Tsujikawa, Hanako; Ueno, Akihisa; Masugi, Yohei; Oshima, Go; Nishiyama, Ryo; Tanaka, Masayuki; Mihara, Kisho; Abe, Yuta; Yagi, Hiroshi; Kitago, Minoru; Itano, Osamu; Kawachi, Shigeyuki; Aiura, Koichi; Tanimoto, Akihiro; Sakamaoto, Michiie; Kitagawa, Yuukou.

In: World Journal of Surgical Oncology, Vol. 11, 75, 21.03.2013.

Research output: Contribution to journalArticle

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AU - Tsujikawa, Hanako

AU - Ueno, Akihisa

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AU - Oshima, Go

AU - Nishiyama, Ryo

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AU - Mihara, Kisho

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AU - Yagi, Hiroshi

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