Endoscopy 2013; 45(S 02): E294-E295
DOI: 10.1055/s-0033-1344587
Cases and Techniques Library (CTL)
© Georg Thieme Verlag KG Stuttgart · New York

Identification of intraductal papillary mucinous neoplasm by esophagogastroduodenoscopy

K. Abe
1  Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
,
A. Isono
1  Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
,
T. Ebato
1  Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
,
T. Yamamoto
1  Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
,
T. Ishii
1  Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
,
H. Kita
1  Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
,
Y. Kuyama
1  Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
,
F. Kondo
2  Department of Pathology, Teikyo University School of Medicine, Tokyo, Japan
› Author Affiliations
Further Information

Publication History

Publication Date:
05 September 2013 (online)

Some reports have described identification of intraductal papillary mucinous neoplasm (IPMN) penetrating to the stomach by esophagogastroduodenoscopy (EGD) [1] [2] [3] [4]. However, it seems that detecting an IPMN from within a postoperative pancreatogastric fistula is very rare.

A 71-year-old man presented with slight fever. He had a history of acute pancreatitis and underwent cystogastrostomy for pancreatic pseudocyst at another institution 8 years earlier. IPMN had not been detected at that time. A detailed examination was carried out, including computed tomography (CT), which revealed a large cystic tumor of the pancreatic head accompanied by a pancreatogastric fistula ([Fig. 1]). Dilatation of the main pancreatic duct was not evident on magnetic resonance cholangiopancreatography ([Fig. 2]). EGD also showed a fistula on the posterior side of the antrum ([Fig. 3]). On passing the scope through the fistula a protruding papillary tumor covered with mucus was noted ([Fig. 4]). Biopsy samples were obtained and histological examination revealed high-grade tubular adenoma. Pancreatoduodenectomy was subsequently carried out and the patient was diagnosed as having branch-type IPMN containing foci of well-differentiated tubular adenocarcinoma ([Fig. 5]). There was no evidence of local invasion or metastasis.

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Fig. 1 Contrast-enhanced computed tomography (CT) in a 71-year-old man with mild fever and a history of acute pancreatitis. There is a large cystic tumor in the head of the pancreas. A pancreatogastric fistula is present within the posterior wall of the stomach.
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Fig. 2 Magnetic resonance cholangiopancreatography showing cystic tumor in the head of the pancreas without dilatation of the main pancreatic duct.
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Fig. 3 Endoscopic view of the pancreatogastric fistula.
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Fig. 4 Endoscopic views. a After passage through the fistula. b Tumor after irrigation.
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Fig. 5 Histological section of the resected specimen showing a well-differentiated tubular adenocarcinoma.

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