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

Abstract

Background There are only 6 cases of intraductal papillary mucinous neoplasm (IPMN) complicated with intraductal hemorrhage have been reported in English literatures. All these 6 cases of IPMN occurred in the old people. The present rare case of IPMN complicated with intraductal hemorrhage occurred in a young woman, and mimicked a cystic solid pseudo-papillary neoplasm (SPN) on preoperative imaging findings. Case presentation A 29-year-old young woman complained of a sustained mild right upper quadrant abdominal pain. CT and MRI showed a lobulated, partly ill-defined cystic lesion located in the pancreatic head. Spotted calcification within cystic wall was seen on CT. The lesion was demonstrated as predominantly homogeneous hyperattenuation on CT and homogeneous high signal without decreased signal on fat suppression sequence on T1WI. After contrast administration, the cystic wall and septa of lesion was showed gradually mild to moderate degree of enhancement over time both on CT and MRI. No communication between lesion and the main duct was found on MRCP and the main pancreatic duct and common bile duct were not dilated. Considering patient’s age, gender and manifestations of lesion on CT and MRI (calcification, bleeding and gradually enhanced pattern), the present case mimicked as a cystic SPN. The lesion was pathologically confirmed a branch type IPMN after surgical resection. Conclusion We propose that IPMN may need to be taken into account in the differential diagnosis when pancreatic cystic lesions occur in young women with bleeding, calcification, progressive enhancement of cystic wall and no communication with the main pancreatic duct.

Current considerations on intraductal papillary neoplasms of the bile duct and pancreatic duct

“…Both age and metabolic syndrome increase the occurrence of IPMNs[ 18 ]. Acute pancreatitis predicts malignancy and constitutes an indication for pancreatectomy[ 19 ]. High-risk stigmata and worrisome features may predict malignant transformation in clinical practice and determine management policy, as shown in Table 1 [ 3 , 20 ].…”

Solid pseudopapillary neoplasm (SPN) of the pancreas: current understanding on its malignant potential and management

“…A retrospective study including 132 cases of definitely radiologically diagnosed SPN indicated that the overall diagnosis rate was 78.5% for CT and 77.8% for MRI [ 31 ]. MRCP result is able to show communication between the lesion and the tumor but has limitations when focusing on recognizing malignant SPNs [ 32 ].…”