Pancreatic intraductal papillary mucinous neoplasm masquerading as ampullary adenoma: a diagnostic puzzle.
Cystic pancreatic lesion
ampullary adenoma
endoscopic papillectomy
intraductal papillary mucinous neoplasm
Journal
Annals of gastroenterology
ISSN: 1108-7471
Titre abrégé: Ann Gastroenterol
Pays: Greece
ID NLM: 101121847
Informations de publication
Date de publication:
Historique:
received:
29
09
2019
accepted:
04
11
2019
entrez:
2
1
2020
pubmed:
2
1
2020
medline:
2
1
2020
Statut:
ppublish
Résumé
Intraductal papillary mucinous neoplasm (IPMN) is the most common pancreatic cystic lesion, remaining mostly asymptomatic. An atypical presentation of such a lesion, initially thought to be an ampullary adenoma, is presented herein. A 78-year-old white male with painless jaundice was treated in a tertiary hospital. Imaging and endoscopic investigations pointed towards an ampullary adenoma obstructing and causing dilatation of both bile and pancreatic ducts. Endoscopic papillectomy was carried out and histology revealed tubulovillous adenoma. Follow-up duodenoscopy 3 months later showed a recurrent lesion with mucous leaking from the pancreatic duct. Cytology revealed mucin-rich atypical cells, consistent with main-duct IPMN. Pancreatoduodenectomy was performed, finally revealing main-duct IPMN protruding through Vater's ampulla. Cystic pancreatic lesions are increasingly found and IPMN is the most common of these. On the other hand, the management of ampullary adenomas has been revolutionized by endoscopic treatment and the advent of endoscopic papillectomy, with expanding indications. Meticulous clinical and imaging work up of these patients is essential to avoid suboptimal treatment. IPMN should be included in the differential diagnosis of ampullary adenomas, especially in the presence of a grossly dilated pancreatic duct.
Identifiants
pubmed: 31892805
doi: 10.20524/aog.2019.0435
pii: AnnGastroenterol-33-98
pmc: PMC6928474
doi:
Types de publication
Case Reports
Langues
eng
Pagination
98-100Informations de copyright
Copyright: © Hellenic Society of Gastroenterology.
Déclaration de conflit d'intérêts
Conflict of Interest: None
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