A Multicentric Development Of Intraductal Papillary Mucinous Neoplasm Treated By Repeated Pancreatectomy

摘要

There are few reports of multicentric recurrence after resection of lesions of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas. We report a case of repeated pancreatectomy for recurrent IPMN showing multicentric development in the pancreatic remnant after resection of the initial lesion. In February 1999 a 70-year-old man underwent distal pancreatectomy for a cystic neoplasm in the pancreatic tail. Histological examination revealed invasive intraductal papillary mucinous adenocarcinoma (IPMC) with lymph node metastasis. Forty-seven months later, a cystic mass with an intracystic nodule was detected during surveillance by computed tomography. The patient underwent completion pancreatectomy. Histological examination demonstrated IPMC with neural invasion. In immunohistochemical staining, the initial specimen was positive for proteinase-activated receptor 2, but the second specimen was not. The present case helps elucidate the multicentric development of IPMN of the pancreas. We recommend careful surveillance for the recurrence of IPMN in the pancreatic remnant after resection. Introduction Intraductal papillary mucinous neoplasm (IPMN) is a well-characterized entity of mucinous cystic neoplasms of the pancreas with malignant potential. The clinicopathological features of IPMNs have been reported frequently in the last decade (1,2,3). Because IPMN is usually a slow-growing neoplasm with low malignancy, surveillance after surgical resection has tended to be less than vigilant. There are several recent reports of recurrence after resection of IPMN (4,5,6). The sites of IPMN recurrence are distant organs or the pancreatic remnant. Although multiple lesions of IPMN in the pancreas are often encountered (7,8), few reports have discussed metachronous or multicentric recurrence in the pancreatic remnant after resection of IPMN. We report a case of recurrence showing the progress of the multicentric development after resection of the initial IPMN. Case Report In February 1999 a 70-year-old man was referred to our hospital for treatment of a cystic neoplasm in the pancreas. Abdominal computed topography (CT) revealed an IPMN 6 cm in diameter in the tail of the pancreas (Fig. 1).