Simultaneous intraductal papillary neoplasms of the bile duct and pancreas treated with chemoradiotherapy |
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Authors: | Valente Roberto Capurso Gabriele Pierantognetti Paola Iannicelli Elsa Piciucchi Matteo Romiti Adriana Mercantini Paolo Larghi Alberto Federici Giulia Francesca Barucca Viola Osti Maria Falchetto Di Giulio Emilio Ziparo Vincenzo Delle Fave Gianfranco |
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Affiliation: | Roberto Valente, Gabriele Capurso, Matteo Piciucchi, Emilio Di Giulio, Gianfranco Delle Fave, Digestive and Liver Disease Unit, Second Medical School, "La Sapienza" University, S. Andrea Hospital, 00189 Rome, Italy. |
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Abstract: | Some authors have suggested that intraductal papillary mucinous neoplasms of the bile duct (IPMN-B) could be the the biliary counterpart of IPMN of the pancreas (IPMN-P) since they share several clinical-pathological features. These include prominent intraductal papillary proliferation pattern, a gastrointestinal phenotype, frequent mucin hyper-secretion and progression to mucinous carcinoma. To date there are just four reported cases of patients with synchronous IPMN-B and IPMN-P all of which were treated surgically. We hereby report the case of a 76-year-old woman who was incidentally diagnosed with both an asymptomatic 3 cm bulky fluid lesion obstructing the bile duct lumen, diagnosed as a malignant IPMN-B, and synchronous multiple pancreatic cystic lesions (10-13 mm) communicating with an irregular Wirsung, diagnosed as branch duct IPMN-P. Since surgery was ruled-out because of the patient's age and preferences, she underwent a conservative management regimen comprising both chemotherapy and radiotherapy. This was effective in decreasing the mass size and in resolving subsequent jaundice. This is also the first reported case of IPMN-B successfully treated with chemoradiotherapy. Clinicians should consider medical treatment as an option in this clinical scenario, in patients who may be unfit for surgery. |
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Keywords: | Intraductal papillary neoplasm Bile duct Simultaneous Pancreatic intraductal papillary mucinous neoplasm |
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