Long-term follow-up of intraductal papillary adenoma of the pancreas |
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Authors: | Kamisawa Terumi Fujiwara Takashi Tu Yuyang Egawa Naoto Tanaka Takeshi Sakaki Nobuhiro Funata Nobuaki Koike Morio |
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Institution: | (1) Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-8677, Tokyo, JP;(2) Department of Pathology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan, JP;(3) Department of Pathology, Tokyo Medical and Dental University, Tokyo, Japan, JP |
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Abstract: | Intraductal papillary mucinous tumors of the main pancreatic duct are often considered to be premalignant or malignant, and
therefore surgical resection is recommended. We report two autopsy cases of intraductal papillary mucinous tumor of the pancreas
following long-term observation. The first patient was an 84-year-old man with early gastric cancer treated by endoscopic
mucosectomy. The second patient was a 77-year-old man with hepatocellular carcinoma treated by percutaneous pure ethanol injection
and transarterial embolization. In both patients, endoscopic retrograde pancreatography showed a diffusely dilated main pancreatic
duct, with intraductal filling defects expressing mucus, as well as dilated side branches. Obvious intramural nodules were
not detected. Due to their advanced age and personal requests, both patients were managed conservatively and followed nonoperatively.
In the first patient, serial pancreatograms showed progression of the pancreatic duct dilatation. Both patients died of gastric
cancer, the first patient 71/2 years and the second, 10 years after first presentation, respectively. Autopsies revealed extensive intraductal papillary
adenoma throughout the dilated mucus-filled main pancreatic duct. However, there was no evidence of progression to adenocarcinoma.
Based on these observations, we suggest that, in patients with intraductal papillary mucinous tumor of the pancreas without
obvious intramural nodules, even if the tumor is in the main pancreatic duct, pancreatectomy may not be mandatory, particularly
in the elderly.
Received: March 21, 2001 / Accepted: July 6, 2001
Reprint requests to: T. Kamisawa |
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Keywords: | : intraductal papillary mucinous tumor intraductal papillary adenoma elderly |
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