Timely and Radical Pancreatic Resection of an Intraductal Papillary Mucinous Neoplasm - a Case Report

Timely and Radical Pancreatic Resection of an Intraductal Papillary Mucinous Neoplasm - a Case Report Objective: Intraductal papillary mucinous neoplasms (IPMN) are the most common cystic pancreatic lesions. Due to the lack of symptoms and unpredictable biological behaviour, IPMN represent a special entity of pancreatic tumours. Indications for resection follow the 'Sendai criteria'. Thus, all main duct IPMN should undergo an operation. The indication for resection of branch duct IPMN in absence of the Sendai criteria concerning suspicions for malignancy (cyst >3 cm, intramural nodules in CT/MRT or symptoms) remains an individual decision. Case Report: We report the case of a 61-year-old patient who presented with a cystic lesion in the pancreatic tail at a routine abdominal ultrasound investigation which was diagnosed as branch duct IPMN with intramural nodules in the subsequent CT scan. Thus, distal pancreatectomy was indicated. Intraoperatively, a frozen section of the resection margin of the pancreas revealed IPMN lesions of the main duct (borderline type). Therefore, completion pancreatectomy was performed. Definitive histological examination revealed an IPMN-associated colloidal adenocarcinoma not only in the tail of the pancreas but also synchronously in the pancreatic head (pT1N0). Conclusion: The early resection of IPMN lesions in the pancreas offers the rare chance of prophylactic and curative therapy of pancreatic cancer. The possibility of synchronous multifocal tumour development needs to be considered in surgical decisions.