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Pancreatic intraductal papillary mucin-producing tumor
PANCREATIC INTRADUCTAL PAPILLARY MUCIN-PRODUCING TUMOR
A
B
C
A 70-year-old woman without significant medical history was referred because of “chronic pancreatitis.” Three years earlier she presented to another institution with intermittent epigastric pain that was relieved by the passage of flatus. Routine blood tests including serum amylase and lipase had been repeatedly normal but CA 19-9 was elevated (244 U/mL, normal <37). Abdominal CT had been interpreted as showing an atrophic pancreas with pseudocysts. Pancreatic enzyme replacement was prescribed.
236
GASTROINTESTINAL ENDOSCOPY
Our evaluation included an abdominal CT that revealed a dilated pancreatic duct (A: left arrow) with several smaller cystic structures in the tail (up arrow). Duodenoscopy disclosed the fishmouth appearance with mucinous plugs (B: left arrow) in both the major and minor papilla. At ERCP (C), both main (short arrowhead) and accessory pancreatic ducts, as well as side branches, were markedly dilated (curved arrow) and amorphous filling defects representing mucinous globules (long arrowhead) were identified in the cystic-appearing portions of the ducts (+). Cytology from the pancreatic ducts revealed atypical duct cells. The patient declined surgery and, except for intermittent epigastric pain, has remained asymptomatic. Thomas Dunzendorfer, MD Pittsfield, Massachusetts doi:10.1067/mge.2000.107292
VOLUME 52, NO. 2, 2000
A
B
C
A 70-year-old woman without significant medical history was referred because of “chronic pancreatitis.” Three years earlier she presented to another institution with intermittent epigastric pain that was relieved by the passage of flatus. Routine blood tests including serum amylase and lipase had been repeatedly normal but CA 19-9 was elevated (244 U/mL, normal <37). Abdominal CT had been interpreted as showing an atrophic pancreas with pseudocysts. Pancreatic enzyme replacement was prescribed.
236
GASTROINTESTINAL ENDOSCOPY
Our evaluation included an abdominal CT that revealed a dilated pancreatic duct (A: left arrow) with several smaller cystic structures in the tail (up arrow). Duodenoscopy disclosed the fishmouth appearance with mucinous plugs (B: left arrow) in both the major and minor papilla. At ERCP (C), both main (short arrowhead) and accessory pancreatic ducts, as well as side branches, were markedly dilated (curved arrow) and amorphous filling defects representing mucinous globules (long arrowhead) were identified in the cystic-appearing portions of the ducts (+). Cytology from the pancreatic ducts revealed atypical duct cells. The patient declined surgery and, except for intermittent epigastric pain, has remained asymptomatic. Thomas Dunzendorfer, MD Pittsfield, Massachusetts doi:10.1067/mge.2000.107292
VOLUME 52, NO. 2, 2000