MALIGNANT INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM: A CASE SERIES AND LITERATURE REVIEW
GCA Carpio, M.D., DM Castro, M.D., FT Dy, M.D., AE Ismael, M.D., MM Chan, M.D. Section of Gastroenterology. Department of Medicine, University of Santo Tomas Hospital
Significance: Intraductal papillary mucinous neoplasm (IPMN) is a relatively rare pancreatic cystic neoplasm with premalignant predisposition. There are already several reports in the literature but, to our knowledge, there are still no published studies in the Philippines. This report focuses on awareness of the usual clinical presentations, imaging/ diagnostic findings and the course of disease so that an early and accurate diagnosis can be achieved with subsequent proper management.
Clinical Presentation: The first case is a 69 year old male with abdominal pain, anorexia, weight loss and occasional steatorrhea. The second is a 76 year old male with abdominal pain, vomiting and weight loss.
Management: For the first, CT scan done showed a cystic, heterogeneously enhancing pancreatic head mass suspicious for neoplasia with PD dilatation and main PD communication, consider IPMN. EUS done showed mucus oozing out of the ampulla with diagnosis of IPMN, main duct type consistent with histopathology. Pancreatic adenocarcinoma was also seen in the analysis. For the second, CT scan showing peripherally- enhancing hypodense lesions, head with PD and CBD dilatation, consider mucinous cystic neoplasm and multiple hepatic lesions, consider metastases. ERCP showed fish mouth ampulla with mucin extruding out. The final diagnosis was malignant IPMN, pancreatic carcinoma Stage IV.
Recommendation: IPMN is a rare condition with high malignant potential. This poses a diagnostic challenge to clinicians. Emphasis on the importance of awareness of the clinical course, correct interpretation of radiologic and endoscopic imaging tests, and accurate histopathological diagnosis can provide early diagnosis leading to proper treatment and prevention of complications.
Keywords: Case report, intraductal papillary mucinous neoplasm, pancreatic cystic neoplasm