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Ding C, Yang JF, Yang B, Lu W, Wang X, Zhou YF, Zhang XF. A pancreaticogastric fistula related to intraductal papillary mucinous neoplasm of the pancreas developed during follow-up: A case report and literature review. J Dig Dis 2024; 25:140-146. [PMID: 38433115 DOI: 10.1111/1751-2980.13255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 03/05/2024]
Affiliation(s)
- Cong Ding
- Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang Province, China
- Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province Hangzhou, Hangzhou, Zhejiang Province, China
| | - Jian Feng Yang
- Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang Province, China
- Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province Hangzhou, Hangzhou, Zhejiang Province, China
| | - Bin Yang
- Department of Radiology, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang Province, China
| | - Wen Lu
- Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang Province, China
- Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province Hangzhou, Hangzhou, Zhejiang Province, China
| | - Xia Wang
- Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang Province, China
- Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province Hangzhou, Hangzhou, Zhejiang Province, China
| | - Yi Feng Zhou
- Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang Province, China
- Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province Hangzhou, Hangzhou, Zhejiang Province, China
| | - Xiao Feng Zhang
- Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang Province, China
- Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province Hangzhou, Hangzhou, Zhejiang Province, China
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AbuDalu M, Munz Y, Ohana G. Pancreatico-gastric fistula arising from IPMN associated with ductal adenocarcinoma of the pancreas: a case report and a literature review. Front Surg 2023; 10:1171234. [PMID: 37292487 PMCID: PMC10244506 DOI: 10.3389/fsurg.2023.1171234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/02/2023] [Indexed: 06/10/2023] Open
Abstract
Introduction An intraductal papillary mucinous neoplasm (IPMN) is a potentially malignant cystic tumor that is characterized by an excessive papillary proliferation of mucin-producing epithelial cells. The IPMN usually exhibits different degrees of dysplasia and is accompanied by cystic dilation of the main pancreatic duct (MPD) or side branch. We report a case of an IPMN that has penetrated the stomach and has differentiated into an adenocarcinoma. Case presentation A 69-year-old female, suffering from chronic pancreatitis of unknown etiology, visited our outpatient clinic with complaints of sudden weight loss, diarrhea, and abdominal pain. She underwent several examinations to evaluate the reasons for her sudden onset of symptoms. A gastroscopy showed an ulcerated lesion covered with mucus. CT and magnetic resonance cholangiopancreatography images revealed that the MPD was dilated to 1.3 cm with a fistula formation between the MPD and the stomach. After a multidisciplinary discussion of this case, a total pancreatectomy was proposed. An en bloc total pancreatectomy with gastric wedge resection including the fistula together with splenectomy was carried out. A Roux-en-Y choledochojejunostomy and gastrojejunostomy were performed. Histology results revealed the association of IPMN with invasive carcinoma. Discussion Many reports on IPMN of the pancreas have been published recently. Fistula formation between IPMN and adjacent organs is possible. Given the CT and endoscopic ultrasonography findings, it shows that in our case a main duct IPMN (MD-IPMN) formed a pancreatico-gastric fistula. We point out that the adherence of invasive cancer cells contributed to the fistula formation between the pancreas and the stomach. Conclusion This case report provides evidence for the possibility of IPMN becoming complicated with pancreatico-gastric fistula. Thus, we suggest that surgical resection should be considered in the case of MD-IPMN because of its high propensity for malignant transformation.
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Jeong MJ. Intraductal papillary mucinous neoplasm mimicking a duodenal tumor. Radiol Case Rep 2023; 18:1103-1106. [PMID: 36684624 PMCID: PMC9849865 DOI: 10.1016/j.radcr.2022.12.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 01/09/2023] Open
Abstract
Intraductal papillary mucinous neoplasms of the pancreas are characterized by ductal dilatation, mucus secretion, and intraductal papillary growth. Intraductal papillary mucinous neoplasms can cause fistulation and extend to adjacent organs. However, they rarely present as large mass in the small bowel that causes bowel obstruction. Herein, we describe a case of intraductal papillary mucinous neoplasm that protruded into the duodenal lumen through the ampulla of Vater, presented as a large duodenal tumor, and developed duodenal obstruction. A 78-year-old woman was admitted to the emergency department with a 2-day history of vomiting and epigastric pain and 2 kg weight-loss in 2 months. Esophagogastroduodenoscopy showed a duodenal mass; however, the endoscope could not pass further, and visualization of the entire tumor was impossible. Computed tomography and magnetic resonance imaging revealed a heterogeneous enhancing mass measuring 8 cm in the second portion of the duodenum, which continued further as an intraductal mass of the pancreas. The main pancreatic duct was dilated, and the parenchyma was atrophied. The biopsy showed a well-differentiated adenocarcinoma and an intact overlying duodenal mucosa. Surgical option of treatment was offered to the patient; however, she refused it due to her advanced age and personal religious beliefs. Thus, we conclude that the experience and knowledge gathered through this patient regarding intraductal papillary mucinous neoplasms could provide further understanding of this disease and evolve subsequent patient care.
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Takahashi H, Adachi Y, Nakahara K, Kikuchi T, Mita H, Nakamura M, Yoshida Y, Kato Y, Ishii Y, Endo T. Intraductal Papillary Mucinous Neoplasm with Pancreatogastric Fistula. Intern Med 2021; 60:1211-1215. [PMID: 33229807 PMCID: PMC8112989 DOI: 10.2169/internalmedicine.5889-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report a rare case of intraductal papillary mucinous neoplasm with a pancreatogastric fistula in an elderly Japanese man admitted to our hospital. The pancreatogastric fistula was confirmed using endoscopic retrograde pancreatography via a cannulated guidewire placed in the stomach. Six months after admission, the patient was diagnosed with intraductal papillary mucinous carcinoma. A pancreatogastric fistula is generally a rare complication of intraductal papillary mucinous neoplasm. It was caused by mechanical penetration in this case. Interestingly, we also observed endoscopic and histochemical mucosal changes in the fistula.
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Affiliation(s)
- Hideaki Takahashi
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Yokohama City Seibu Hospital, Japan
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Japan
| | - Yasushi Adachi
- Department of Internal Medicine, Division of Gastroenterology, Sapporo Shirakabadai Hospital, Japan
| | - Kazunari Nakahara
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Japan
| | - Takefumi Kikuchi
- Department of Internal Medicine, Division of Gastroenterology, Sapporo Shirakabadai Hospital, Japan
| | - Hiroaki Mita
- Department of Internal Medicine, Division of Gastroenterology, Sapporo Shirakabadai Hospital, Japan
| | - Masahiro Nakamura
- Department of Internal Medicine, Division of Gastroenterology, Sapporo Shirakabadai Hospital, Japan
| | - Yukinari Yoshida
- Department of Internal Medicine, Division of Gastroenterology, Sapporo Shirakabadai Hospital, Japan
| | - Yasuo Kato
- Department of Internal Medicine, Division of Gastroenterology, Sapporo Shirakabadai Hospital, Japan
| | - Yoshifumi Ishii
- Department of Pathology, Sapporo Shirakabadai Hospital, Japan
| | - Takao Endo
- Department of Internal Medicine, Division of Gastroenterology, Sapporo Shirakabadai Hospital, Japan
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Invasive Intraductal Papillary Mucinous Neoplasms: CT Features of Colloid Carcinoma Versus Tubular Adenocarcinoma of the Pancreas. AJR Am J Roentgenol 2020; 214:1092-1100. [PMID: 32130045 DOI: 10.2214/ajr.19.21824] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE. The purpose of this study is to compare the CT features of colloid carcinoma and tubular adenocarcinoma of the pancreas arising in association with intraductal papillary mucinous neoplasms (IPMNs). MATERIALS AND METHODS. The preoperative CT images of 85 patients with histopathologically proven IPMNs and associated invasive adenocarcinoma located next to each other were retrospectively reviewed. Twenty-nine patients (34.1%; 19 men and 10 women; mean [± SD] age, 68.0 ± 9.5 years) had invasive colloid carcinoma, and 56 patients (65.9%; 31 men and 25 women; mean age, 70.8 ± 10.6 years) had invasive tubular adenocarcinoma. We compared the following CT features between the two groups: IPMN type, main pancreatic duct (MPD) and common bile duct diameters, diameter and characteristics of the largest cystic lesion for branch duct and mixed-type IPMNs, presence of an extracystic or extraductal solid mass next to the cystic lesion or MPD, morphologic features of the upstream MPD in relation to the cystic lesion or solid mass, and presence of a fistula to the adjacent organs. RESULTS. An MPD size of 9.5 mm or greater, a largest cystic lesion diameter of 28 mm or greater, location in the head or neck, septation, calcification, presence of a mural nodule(s) within a cystic lesion or MPD, and presence of a fistula were all more commonly associated with colloid carcinoma. In contrast, presence of an extracystic or extraductal solid mass and an abrupt change in the caliber of the dilated MPD were associated with tubular adenocarcinoma. The best CT feature for differentiating between the two groups was the morphologic features of the upstream MPD in relation to the cystic lesion or solid mass (sensitivity, 81.3%; specificity, 92.3%). CONCLUSION. Preoperative CT is helpful in differentiating two types of invasive carcinoma arising in association with IPMNs. These findings are clinically important because prognosis is better for colloid carcinoma than for tubular adenocarcinoma.
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Cortegoso Valdivia P, Bruno M, Gaia S, Saracco GM, De Angelis C. A rare case of gastric fistulization of a main-duct intraductal papillary mucinous neoplasm. MINERVA GASTROENTERO 2018; 64:383-385. [PMID: 29553226 DOI: 10.23736/s1121-421x.18.02486-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We report a rare case of gastric fistulization in a patient with main-duct (MD) intraductal papillary mucinous neoplasm (IPMN). Fistulization to adjacent organs is a rare complication of this disease, mainly affecting the duodenum; the fact that the stomach was the only organ involved makes this case even more peculiar. The diagnosis of the fistula was made after examination with endoscopic ultrasound, since a previous computed tomography scan could not detect it.
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Affiliation(s)
- Pablo Cortegoso Valdivia
- Department of Gastroenterology and Digestive Endoscopy, A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy -
| | - Mauro Bruno
- Department of Gastroenterology and Digestive Endoscopy, A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Silvia Gaia
- Department of Gastroenterology and Digestive Endoscopy, A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - Claudio De Angelis
- Department of Gastroenterology and Digestive Endoscopy, A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
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Nam K, Choi JH. Main duct intraductal papillary mucinous neoplasm of the pancreas developing a pancreaticogastric fistula while in follow up. Dig Endosc 2017; 29:231-232. [PMID: 27783869 DOI: 10.1111/den.12758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Kwangwoo Nam
- Division of Gastroenterology, Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Jun-Ho Choi
- Division of Gastroenterology, Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
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Ravaud S, Laurent V, Jausset F, Cannard L, Mandry D, Oliver A, Claudon M. CT and MR imaging features of fistulas from intraductal papillary mucinous neoplasms of the pancreas to adjacent organs: A retrospective study of 423 patients. Eur J Radiol 2015; 84:2080-8. [PMID: 26321495 DOI: 10.1016/j.ejrad.2015.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 07/20/2015] [Accepted: 08/03/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE The objectives of this study were to determine the frequency with which intraductal papillary mucinous pancreatic neoplasms (IPMNs) show fistulization to adjacent organs and to describe the multidetector row computed tomography (MDCT) and magnetic resonance imaging (MRI) findings for this specific complication. METHODS A retrospective analysis of the clinical and imaging files of all patients with IPMNs who were followed over 8 years by our department was performed to identify those with fistula formation. Two radiologists determined the type of IPMN, the number and size of visible fistulas, the involved adjacent organs, the pancreatic location and the presence of imaging findings suggestive of malignant transformation of the IPMN. Histological correlation was also performed. RESULTS A total of 423 patients were included. Fistula formation was present in 8 patients (1.9%). The corresponding IPMNs were of the main duct type (n=4; 50%), the branch duct type (n=1; 13%) or the mixed type (n=3; 38%). In half of the cases, these tumors were discovered incidentally. A total of 26 fistulas (1-7 per patient) were identified. These fistulas involved the duodenum (65.4%), stomach (19.2%), common bile duct (11.5%) and colon (3.8%). All patients had fistulas to the duodenum. All fistulas appeared to develop from a malignant IPMN based on the imaging studies, but two of the five available samples did not exhibit atypia (a quarter of all fistulas). In 50% of cases, the IPMN was of the intestinal form. CONCLUSIONS Fistulas are uncommon complications of IPMNs, regardless of malignant transformation of the IPMNs. Fistulas appear to predominate among malignant main-duct IPMNs, are generally multiple and affect several organs, and their preferential target is the duodenum. However, fistulas do not adhere to a strict criterion of malignancy.
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Affiliation(s)
- Simon Ravaud
- Hôpital Brabois, Rue du Morvan, 54 511 Vandoeuvre-lès-Nancy, France.
| | - Valérie Laurent
- Hôpital Brabois, Rue du Morvan, 54 511 Vandoeuvre-lès-Nancy, France.
| | | | - Lionel Cannard
- Centre d'Imagerie Jacques Callot, 13 bis rue Blaise Pascal, 54320 Maxéville, France.
| | - Damien Mandry
- Hôpital Brabois, Rue du Morvan, 54 511 Vandoeuvre-lès-Nancy, France.
| | | | - Michel Claudon
- Hôpital Brabois, Rue du Morvan, 54 511 Vandoeuvre-lès-Nancy, France.
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Pancreatic intraductal papillary mucinous neoplasm invading the duodenum: a case report and a review of the literature. Pancreas 2014; 43:490-1. [PMID: 24622089 DOI: 10.1097/mpa.0000000000000058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Tajima N, Utano K, Kijima S, Kawai A, Fujita A, Sakuma K, Sugimoto H, Fujii H. Intraductal papillary mucinous neoplasm penetrating to the stomach, duodenum, and jejunum demonstrated on MR cholangiopancreatography with an oral negative contrast agent. J Magn Reson Imaging 2012; 38:206-9. [PMID: 23148046 DOI: 10.1002/jmri.23915] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 09/27/2012] [Indexed: 12/16/2022] Open
Abstract
A 65-year-old man was referred to our hospital due to epigastric pain. Abdominal enhanced computed tomography (CT) demonstrated marked dilatation of the main pancreatic duct (MPD) and communication to the gastric and duodenal lumen was suspected. Esophagogastroduodenoscopy (EGD) showed a villous tumor with white mucous discharge in the posterior wall of the gastric corpus and duodenal bulb. Pathological specimens showed mucin-producing epithelium with nuclear atypia that had developed in a papillary form. Based on these findings, we diagnosed intraductal papillary mucinous neoplasm (IPMN) arising in the MPD with penetration into the gastric and duodenal lumen. Magnetic resonance cholangiopancreatography (MRCP) with an oral negative contrast agent (manganese chloride tetrahydrate) showed a fistulous tract not only to the stomach and duodenum, but also to the jejunum. MRCP demonstrated mucous streaming with remarkably high intensity. In this case, an oral negative contrast agent was useful to distinguish mucous discharge from gastric fluid, facilitating the diagnosis of penetration to the jejunum. This finding was unobtainable by CT or EGD. When IPMN penetrating to other organs is suspected, MRCP with an oral negative contrast agent may provide important information.
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Affiliation(s)
- Naoshi Tajima
- Department of Radiology, Jichi Medical University, Tochigi, Japan
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Abstract
A variety of abdominal and pelvic tumors can present with rupture leading to hemoperitoneum/hemoretroperitoneum or peritonitis. Imaging plays an important role in the diagnosis of hemorrhage or peritonitis as well as in the detection of ruptured tumors or organs. In this article, we illustrate the imaging findings of ruptured tumors arising in the abdominal and pelvic organs while excluding those of ruptured tumors arising in the stomach and intestines. It is important for the radiologists to understand the mechanisms involved in tumor rupture and recognize the imaging features of ruptured tumors according to the organs involved because this will permit the exact diagnosis of ruptured tumors, thereby facilitating prompt and effective treatment.
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Affiliation(s)
- Sang Won Kim
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Hyun Cheol Kim
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Dal Mo Yang
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
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Mohammadi A, Porghasem J, Esmaeili A, Ghasemi-rad M. Spontaneous rupture of a pancreatic acinar cell carcinoma presenting as an acute abdomen. Int J Surg Case Rep 2012; 3:293-295. [PMID: 22543229 PMCID: PMC3356555 DOI: 10.1016/j.ijscr.2012.03.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 03/20/2012] [Accepted: 03/25/2012] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Pancreatic acinar cell carcinoma is a rare malignant pancreatic neoplasm. To the best of our knowledge, there has been no report on spontaneous rupture of acinar cell carcinoma. PRESENTATION OF CASE A 39-year-old Azari male presented with a history of sudden onset, acute epigastric pain of 12-h duration. Eight hours later the patient's general condition rapidly deteriorated, blood pressure was decreased to 90/70mm/Hg and heart rate was increased to 120beat/min. Emergent abdominal computed tomography scan showed a well-defined hypo-dense, necrotic mass, measured 12cm×12cm that was originating from the uncinate process of pancreas with marked free peritoneal fluid and extensive haziness of retroperitoneal and mesenteric fat compatible with marked bleeding. Emergent abdominal operation was performed and histopathology revealed acinar cell carcinoma of the pancreas. DISCUSSION Pancreatic acinar cell carcinoma (ACC) usually presents with abdominal pain, nausea and vomiting. To best of our knowledge, no report has been made of spontaneous rupture of ACC. CONCLUSION Pancreatic carcinoma may present as acute abdomen due to rupture of underlying neoplasm.
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Affiliation(s)
- Afshin Mohammadi
- Urmia University of Medical Sciences, West Azarbaijan, Urmia, Iran
| | - Jalal Porghasem
- Urmia University of Medical Sciences, West Azarbaijan, Urmia, Iran
| | - Arefeh Esmaeili
- Urmia University of Medical Sciences, West Azarbaijan, Urmia, Iran
| | - Mohammad Ghasemi-rad
- Urmia University of Medical Sciences, School of Medicine, Student Research Center, West Azarbaijan, Urmia, Iran
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Peroral pancreatoscopic images of the site of mechanical penetration of the choledochus combined with narrow-band imaging in a patient with main duct intraductal papillary mucinous neoplasm of the pancreas. Gastrointest Endosc 2011; 73:627-9. [PMID: 21067746 DOI: 10.1016/j.gie.2010.08.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Accepted: 08/11/2010] [Indexed: 02/08/2023]
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Kobayashi G, Fujita N, Noda Y, Ito K, Horaguchi J, Obana T, Koshida S, Kanno Y, Yamashita Y, Kato Y, Ogawa T, Oikawa M, Tsuchiya T, Sawai T. Intraductal papillary mucinous neoplasms of the pancreas showing fistula formation into other organs. J Gastroenterol 2010; 45:1080-9. [PMID: 20549253 DOI: 10.1007/s00535-010-0263-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 04/19/2010] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study assessed the mechanism of fistula formation in intraductal papillary mucinous neoplasm (IPMN) of the pancreas. METHODS A total of 274 patients with IPMN who had been diagnosed by endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography (EUS) at our center were enrolled. The patients with IPMN which had fistula formation into other organs were investigated retrospectively as to (1) clinical prevalence and the organs penetrated by IPMN, (2) analysis of the mechanism of fistula formation by immunohistopathological study, (3) efficacy of EUS in progression assessment, and (4) prognosis. RESULTS Among the subjects, fistula formation into other organs was observed in 18 patients (6.6%) and into 28 organs. There were 7 patients (39%) in whom multiple organs were penetrated. Of 16 patients who had undergone investigation of the expression of mucin markers, 94% had an intestinal-type tumor. Of 9 patients who had undergone surgery or autopsy, 67% showed mechanical penetration without invasion around the fistula. Only papillary protrusions were seen by EUS in 4 of these patients with noninvasive papillary adenocarcinoma showing mechanical penetration. All 5 patients who had pancreatic parenchymal invasion showed a mass with a mixed-echo pattern in addition to papillary protrusions shown by EUS, corresponding to colloid carcinoma. CONCLUSIONS There were 2 processes in the development of fistulas in IPMN. Of those patients showing fistula formation, 94% had intestinal-type IPMN, and 67% showed mechanical penetration. Delineation of a mass with the mixed-echo pattern suggested an invasive penetration due to colloid carcinoma.
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Affiliation(s)
- Go Kobayashi
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, Miyagi, Japan.
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