Endocrine tumor and intraductal papillary mucinous neoplasm of the pancreas: a fortuitous association?
OBJECTIVE
Pancreatic endocrine tumors (PETs) and intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are rare diseases of the pancreas. Cases of association of endocrine and exocrine neoplasms of the pancreas have been reported, corresponding to mixed or amphicrine tumors. The aim of this report is to describe a series of 6 patients with an original association of IPMN and PET of the pancreas.


METHODS
Among 108 and 103 patients operated on in our center between January 1997 and December 2003 for PETs and IPMNs, respectively, we identified 6 patients with both PET and IPMN, diagnosed on pathologic examination with an immunohistochemical study.


RESULTS
Preoperative diagnosis was unspecified pancreatic tumor (n = 1), IPMN (n = 2), and association of PET and IPMN (n = 3). IPMN involved the main pancreatic duct in 4 patients and was classified as benign (n = 4), borderline (n = 1), or malignant noninvasive (n = 1). PETs measured 1.1 to 3 cm and were malignant in 1 patient (lymph node invasion). When analyzed by immunohistochemistry, 2 cases expressed glucagon, 1 expressed somatostatin, and 1 expressed insulin.


CONCLUSIONS
This study describes a new aspect of endocrine-exocrine pancreatic neoplasm association. The frequency of the association of PET and IPMN is too large to be fortuitous. Further studies are needed to understand its mechanism.
Marrache
Frédéric
F
Service de Gastroentérologie, Fédération Médicochirurgicale d'Hépato-Gastroentérologie, Hôpital Beaujon, AP-HP, Clichy, France.
Cazals-Hatem
Dominique
D
Kianmanesh
Reza
R
Palazzo
Laurent
L
Couvelard
Anne
A
O'Toole
Dermot
D
Maire
Frédérique
F
Hammel
Pascal
P
Levy
Philippe
P
Sauvanet
Alain
A
Ruszniewski
Philippe
P
D002288:Adenocarcinoma, Mucinous / Q000737:chemistry / Q000473:pathology*; D000328:Adult; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000737:chemistry / Q000473:pathology*; D002291:Carcinoma, Papillary / Q000737:chemistry / Q000473:pathology*; D053379:Chromogranin A; D002864:Chromogranins / Q000032:analysis; D004701:Endocrine Gland Neoplasms / Q000737:chemistry / Q000473:pathology*; D005260:Female; D005934:Glucagon / Q000032:analysis; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000737:chemistry / Q000473:pathology*
D053379:Chromogranin A; D002864:Chromogranins; D005934:Glucagon