Small invasive ductal carcinoma of the pancreas distinct from branch duct intraductal papillary mucinous neoplasm

Figure 1 Contrast-enhanced computed tomography (CE-CT) scan of pancreas. A: A cystic lesion in pancreatic body (arrows); B: A dilatation of the main duct in the pancreatic tail. Solid masses were not observed.

Figure 2 Magnetic resonance cholangiopancreatography (MRCP) at initial examination showing dilatation of the branch duct.

Figure 3 The size of the branch ducts was unchanged one year after the last MRCP.

Figure 4 Endoscopic ultrasonography (EUS) at two years later examination showing pancreatic tail. A: EUS showing low echoic lesion which is vague and the area had unclear margins in the pancreatic tail; B: Contrast-enhanced harmonic EUS showing a clear margin of 10 mm in diameter and hypovascular nodule compared with surrounding pancreatic tissue (arrows). MPD: Main pancreatic duct (arrowheads).

Figure 5 Scheme showing the pancreatic body and tail by pancreatoduodenectomy. A: Intraductal papillary tumor of the pancreatic body; B: Invasive adenocarcinoma of the pancreatic tail.

Figure 6 Histological appearance of two lesions (HE). A: Intraductal papillary mucinous adenoma; B: Moderately differentiated tubular adenocarcinoma.