Case Report
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World J Gastroenterol. Jul 21, 2014; 20(27): 9200-9204
Published online Jul 21, 2014. doi: 10.3748/wjg.v20.i27.9200
Concomitant pancreatic adenocarcinoma in a patient with branch-duct intraductal papillary mucinous neoplasm
Joanna K Law, Christopher L Wolfgang, Matthew J Weiss, Anne Marie Lennon
Joanna K Law, Christopher L Wolfgang, Matthew J Weiss, Anne Marie Lennon, Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD 21287, United States
Author contributions: Law JK was involved in the concept, data acquisition and writing of this manuscript, and approval of the final manuscript; Wolfgang CL and Weiss MJ were involved in the editing of the manuscript and final approval of the submitted version; Lennon AM developed the concept, wrote, and edited the manuscript.
Supported by The Full Moon Full Life fund and, in part, the Open Access Promotion Fund of Johns Hopkins University Libraries; Dr Law is the Volker Dolch Fellow in Gastroenterology at Johns Hopkins Hospital
Correspondence to: Anne Marie Lennon, MB, PhD, Division of Gastroenterology, Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7125J, Baltimore, MD 21287, United States. amlennon@jhmi.edu
Telephone: +1-410-9555800 Fax: +1-410-6148337
Received: October 14, 2013
Revised: December 31, 2013
Accepted: February 26, 2014
Published online: July 21, 2014
Processing time: 280 Days and 3.8 Hours
Abstract

Branch duct intraductal papillary mucinous neoplasms (BD-IPMN) are pre-malignant pancreatic cystic lesions which carry a small risk of malignant transformation within the cyst. Guidelines exist with respect to surveillance of the cysts using computed tomography, magnetic resonance imaging, and/or endoscopic ultrasound (EUS). There are reports that patients with IPMNs are at increased risk of developing pancreatic adenocarcinoma, which arises in an area separate to the IPMNs. We present two cases of pancreatic adenocarcinoma arising within the parenchyma, distinct from the IPMN-associated cyst, identified with EUS. This case report highlights that patients with BD-IPMN are at increased risk for pancreatic adenocarcinoma separate from the cyst and also the importance for endosonographers to carefully survey the rest of the pancreatic parenchyma separate from the cyst in order to identify small pancreatic adenocarcinomas.

Keywords: Pancreatic adenocarcinoma; Intraductal papillary mucinous neoplasm; Endoscopic ultrasound; Surveillance

Core tip: Patients with intraductal papillary mucinous neoplasm are not only at risk for malignant degeneration within the cyst, but some reports have indicated an increased risk for the development of pancreatic adenocarcinoma separate from the cyst. The current international guidelines emphasize surveillance of the cyst but this case report highlights the importance for endosonographers to carefully evaluate parenchyma not involved with the cyst to identify small pancreatic adenocarcinomas.