A case of intraductal papillary-mucinous neoplasm of the pancreas penetrating into the stomach and spleen successfully treated by total pancreatectomy

Abstract

BackgroundIntraductal papillary-mucinous neoplasms (IPMNs) are potentially malignant intraductal epithelial neoplasms that sometimes penetrate into other organs. To the best of our knowledge, no report has yet described a case with penetration into the spleen. We recently encountered a case of IPMN with penetration of the stomach and spleen that was successfully treated by total pancreatectomy.Case presentationA 70-year-old female visited our hospital with a complaint of fever and abdominal pain. Contrast-enhanced computed tomography (CT) revealed dilatation of the main pancreatic duct in the entire pancreas and penetration into the stomach and spleen. Upper gastrointestinal endoscopy revealed mucin extruding from four openings of the fistula in the stomach. No malignancy was detected based on cytology of the mucin. Inflammation markers and tumor markers (CEA, CA19–9) were elevated in the blood. The pre-operative diagnosis was IPMN of main pancreatic duct type penetrating into the stomach and spleen. A total pancreatectomy and splenectomy were performed, combined with distal gastrectomy including resection of the fistulas between the pancreas and stomach. No postoperative complications were noted. Histopathological examination of the resected specimen revealed atrophy of the pancreatic parenchyma, and the main duct of the pancreas was filled with mucin. Mucin-producing malignant tumor cells were detected in the epithelium of the main pancreatic duct with no signs of invasion. No malignancy was found at the fistulas between the pancreas and stomach or spleen. The patient was finally diagnosed with non-invasive intraductal papillary-mucinous carcinoma (IPMC) of main pancreatic duct type. Mechanical penetration was suspected as a mechanism of the penetration. The patient remained disease-free without evidence of recurrence more than 15 months after the operation.ConclusionThough IPMNs sometimes penetrate into other adjacent organs, penetration into two organs, including the spleen, is rare. The rare case of IPMC penetrating into the stomach and spleen presented here was treated successfully by total pancreatectomy.

Fistula formation into other organs secondary to intraductal papillary mucinous neoplasm of the pancreas: A case report and literature review

“…Fistula formation into solid organs, such as the spleen, is rare compared to luminal organs due to the higher resistance of solid organs to increased intraductal pancreatic pressure, which is assumed to be one of the mechanisms for fistula development. [36] Fistula formation into multiple organs was detected in 29 cases (29/83 cases, 35%), and the most frequent combination was the stomach and the duodenum. However, the interpretation of organ prevalence should be conducted with caution.…”

Intraductal papillary mucinous neoplasm complicated with intraductal bleeding in a young woman mimicked a cystic solid pseudo-papillary tumor: a case report

“…IPMN can complicate with acute pancreatitis (AP) [ 3 , 4 ], duct perforation, fistula formation into the adjacent lumen organs (the duodenum, common bile duct, stomach, colon and small intestine) [ 5 , 6 ] and spleen solid organ [ 7 ], intraductal bleeding or a massive abdominal cavity hematoma caused by rupture [ 1 , 2 ], and cyst infection [ 8 ], according to previous studies. AP is the most common complications of IPMN, approximately 20% of IPMN complicated with acute pancreatitis of mild to moderate severity [ 4 ].…”

“…No communication between lesion and the main duct was found on MRCP images and the main pancreatic duct and common bile duct were not dilated(Figs. 2, 3, 4,5,6,7,8,9,10,11)…”

Preoperative confirmation of the accurate location of a fistula using endoscopy and fluoroscopy in a patient with intraductal papillary‐mucinous carcinoma of the pancreas penetrating the stomach and colon

“…Intraductal papillary‐mucinous neoplasm (IPMN) invades other organs, leading to the formation of fistulas 1‐4 . IPMN can potentially become malignant 5 .…”

“…Intraductal papillary-mucinous neoplasm (IPMN) invades other organs, leading to the formation of fistulas. [1][2][3][4] IPMN can potentially become malignant. 5 We report a case of intraductal papillary-mucinous carcinoma (IPMC) that formed a fistula between the stomach and colon, which was confirmed preoperatively.…”