Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 16, 2024; 12(8): 1487-1496
Published online Mar 16, 2024. doi: 10.12998/wjcc.v12.i8.1487
High-grade pancreatic intraepithelial neoplasia diagnosed based on changes in magnetic resonance cholangiopancreatography findings: A case report
Nao Furuya, Atsushi Yamaguchi, Naohiro Kato, Syuhei Sugata, Takuro Hamada, Takeshi Mizumoto, Yuzuru Tamaru, Ryusaku Kusunoki, Toshio Kuwai, Hirotaka Kouno, Kazuya Kuraoka, Yoshiyuki Shibata, Sho Tazuma, Takeshi Sudo, Hiroshi Kohno, Shiro Oka
Nao Furuya, Atsushi Yamaguchi, Naohiro Kato, Syuhei Sugata, Takuro Hamada, Takeshi Mizumoto, Yuzuru Tamaru, Ryusaku Kusunoki, Toshio Kuwai, Hirotaka Kouno, Hiroshi Kohno, Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Hiroshima, Japan
Nao Furuya, Takuro Hamada, Shiro Oka, Department of Gastroenterology, Hiroshima University Hospital, Hiroshima 734-8551, Hiroshima, Japan
Kazuya Kuraoka, Department of Pathology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Hiroshima, Japan
Yoshiyuki Shibata, Sho Tazuma, Takeshi Sudo, Department of Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Hiroshima, Japan
Author contributions: Furuya N made substantial contributions to the study conception and design; Furuya N and Yamaguchi A were responsible for writing the original draft, and reviewing and editing the manuscript; Kato N, Sugata S, Hamada T, Shibata Y, and Tazuma S performed the data collection; Mizumoto T, Tamaru Y, Kusunoki R, Kuwai T, Kouno H, Sudo T, Kohno H, and Oka S revised the manuscript; Kuraoka K performed pathological diagnosis; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare no conflict of interest related to this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Atsushi Yamaguchi, MD, PhD, Chief Doctor, Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, No. 3-1 Aoyama-cho, Kure 737-0023, Hiroshima, Japan. yamaguchi.atsushi.uc@mail.hosp.go.jp
Received: December 12, 2023
Peer-review started: December 12, 2023
First decision: December 31, 2023
Revised: January 15, 2024
Accepted: February 20, 2024
Article in press: February 20, 2024
Published online: March 16, 2024
Abstract
BACKGROUND

High-grade pancreatic intraepithelial neoplasia (PanIN) exhibits no mass and is not detected by any examination modalities. However, it can be diagnosed by pancreatic juice cytology from indirect findings. Most previous cases were diagnosed based on findings of a focal stricture of the main pancreatic duct (MPD) and caudal MPD dilatation and subsequent pancreatic juice cytology using endoscopic retrograde cholangiopancreatography (ERCP). We experienced a case of high-grade PanIN with an unclear MPD over a 20-mm range, but without caudal MPD dilatation on magnetic resonance cholangiopancreatography (MRCP).

CASE SUMMARY

A 60-year-old female patient underwent computed tomography for a follow-up of uterine cancer post-excision, which revealed pancreatic cysts. MRCP revealed an unclear MPD of the pancreatic body at a 20-mm length without caudal MPD dilatation. Thus, course observation was performed. After 24 mo, MRCP revealed an increased caudal MPD caliber and a larger pancreatic cyst. We performed ERCP and detected atypical cells suspected of adenocarcinoma by serial pancreatic juice aspiration cytology examination. We performed a distal pancreatectomy and obtained a histopathological diagnosis of high-grade PanIN. Pancreatic parenchyma invasion was not observed, and curative resection was achieved.

CONCLUSION

High-grade Pan-IN may cause MPD narrowing in a long range without caudal MPD dilatation.

Keywords: Pancreatic cancer, Pancreatic intraepithelial neoplasm, High-grade pancreatic intraepithelial neoplasm, Magnetic resonance cholangiopancreatography, Carcinoma in situ, Case report

Core Tip: High-grade pancreatic intraepithelial neoplasia (PanIN) is diagnosed using pancreatic juice cytology. Most reasons for performing endoscopic retrograde cholangiopancreatography (ERCP) are focal main pancreatic duct (MPD) stenosis and/or caudal MPD dilatation. Poor MPD depiction without caudal MPD dilatation on magnetic resonance cholangiopancreatography sometimes occurs in normal individuals. Thus, we hesitate to send these patients to undergo ERCP. As such, course observation is necessary to confirm whether or not caudal MPD dilatation and/or cyst formation develop(s). Accordingly, it is better to submit the patient to ERCP to detect high-grade PanIN if caudal MPD dilatation and/or cyst formation occur(s).