Case Report
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World J Gastrointest Oncol. Feb 15, 2012; 4(2): 22-25
Published online Feb 15, 2012. doi: 10.4251/wjgo.v4.i2.22
Simultaneous intraductal papillary neoplasms of the bile duct and pancreas treated with chemoradiotherapy
Roberto Valente, Gabriele Capurso, Paola Pierantognetti, Elsa Iannicelli, Matteo Piciucchi, Adriana Romiti, Paolo Mercantini, Alberto Larghi, Giulia Francesca Federici, Viola Barucca, Maria Falchetto Osti, Emilio Di Giulio, Vincenzo Ziparo, Gianfranco Delle Fave
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
Paola Pierantognetti, Nursery Science Second Medical School, “La Sapienza” University, 00189 Rome, Italy
Elsa Iannicelli, Giulia Francesca Federici, Radiology Unit, “La Sapienza” University, 00189 Rome, Italy
Adriana Romiti, Viola Barucca, Oncology Unit, “La Sapienza” University, 00189 Rome, Italy
Paolo Mercantini, Vincenzo Ziparo, General Surgery Unit, “La Sapienza” University, 00189 Rome, Italy
Alberto Larghi, Digestive Endoscopy Unit, Catholic University, 000192 Rome, Italy
Maria Falchetto Osti, Radiotheraphy Unit, “La Sapienza” University, 00189 Rome, Italy
Author contributions: Capurso G and Delle Fave G designed the research; Valente R, Pierantognetti P, Piciucchi M, Iannicelli E, Romiti A, Mercantini P, Larghi A, Federici GF, Baracca V, Osti MF, Di Giulio E and Ziparo V contributed to data acquisition and drafting; Valente R, Capurso G, Larghi A and Delle Fave G wrote the paper; all authors revised the paper and approved the final version.
Correspondence to: Gianfranco Delle Fave, Professor, Digestive and Liver Disease Unit, Second Medical School, “La Sapienza” University, S. Andrea Hospital, Via Di Grottarossa 1035, 00189 Rome, Italy.
Telephone: +39-6-33775691 Fax: +39-6-33775526
Received: August 30, 2011
Revised: December 16, 2011
Accepted: December 23, 2011
Published online: February 15, 2012

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.

Keywords: Intraductal papillary neoplasm, Bile duct, Simultaneous, Pancreatic intraductal papillary mucinous neoplasm