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A pancreatobiliary-type carcinoma in situ at the periphery of a mural nodule developed from a gastric adenoma in an intraductal papillary mucinous neoplasm

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Abstract

We report a rare case of an intraductal papillary mucinous neoplasm (IPMN) with a pancreatobiliary-type carcinoma in situ (CIS) that originated around a mural nodule formed in a gastric-type adenoma. A 64-year-old man was admitted to our hospital in December 2001 for dilation of the main pancreatic duct, detected on abdominal ultrasonography. Branch-duct-type IPMN (diameter 25 mm) was diagnosed, and because mural nodules were absent, the patient was annually followed up for 5 years. In 2006, computed tomography scans revealed thickening of the tumor wall and the development of a mural nodule (diameter approximately 6 mm); pancreatoduodenectomy with regional lymph-node dissection was performed. Histopathologic examination showed an intraductal papillary mucinous carcinoma arising from an adenoma. Hematoxylin and eosin (H&E) staining revealed that most of the tumor components, including the mural nodule, had adenomatous changes, indicating the tumor to be of the gastric type; however, immunohistochemistry showed positive MUC2 expression. Histologically, the tissues around the nodule, including those showing a cribriform pattern, were diagnosed as CIS. These tissues were classified as the pancreatobiliary-type on the basis of the results of both H&E staining and immunohistochemistry. The patient remained disease-free for 3 years after surgery.

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Authors and Affiliations

  1. Department of Gastroenterological General, Breast and Thyroid Surgery, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan

    Naoki Takasu, Wataru Kimura, Toshiyuki Moriya, Akiko Takeshita, Saijiro Murayama & Ichiro Hirai

  2. Department of Human Pathology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan

    Shinya Ogata

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  1. Naoki Takasu
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  2. Wataru Kimura
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  3. Toshiyuki Moriya
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  4. Akiko Takeshita
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  5. Saijiro Murayama
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  6. Ichiro Hirai
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  7. Shinya Ogata
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Correspondence to Wataru Kimura.

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Takasu, N., Kimura, W., Moriya, T. et al. A pancreatobiliary-type carcinoma in situ at the periphery of a mural nodule developed from a gastric adenoma in an intraductal papillary mucinous neoplasm. Clin J Gastroenterol 3, 209–213 (2010). https://doi.org/10.1007/s12328-010-0162-0

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  • DOI: https://doi.org/10.1007/s12328-010-0162-0

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