title: Intraductal papillary mucinous neoplasm (IPMN) of the gastric-type with focal nodular growth of the arborizing papillae: a case of high-grade transformation of the gastric-type IPMN.
abstract: We present a case of intraductal papillary mucinous neoplasm (IPMN) of the pancreas, demonstrating a process of high-grade transformation of the gastric-type IPMN. An 83-year-old Japanese woman underwent pylorus-preserving pancreatoduodenectomy for removal of a multicystic mass of the pancreas head, which had been followed up for 7 years. The removed tumor was a low-grade gastric-type IPMN spreading in the branch ducts, focally forming an intraluminal nodular lesion. The nodular lesion was comprised of arborizing papillotubular proliferation of cuboidal to columnar epithelia with high-grade atypia, and was characterized by diffuse MUC1 expression and a gastric mucin phenotype (focal MUC5AC and MUC6 expressions). Therefore, the nodular lesion was consistent with the pancreatobiliary-type IPMN, and the present case suggests that the low-grade gastric-type IPMN may progress to a focal intraductal carcinoma over the years, and the pancreatobiliary-type IPMN may be one of the forms of such high-grade transformation of the gastric-type IPMN. One of the cystic lesions was an oligocystic-type serous cystic neoplasm (serous cystadenoma), which might be an incidental concomitance or have a common basis.
authors.affiliation: Department of Pathology, Saitama Medical School, 38 Morohongo, Moroyama, Iruma, Saitama 350-0495, Japan. shinba@saitama-med.ac.jp
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ban
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Naitoh
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Ogawa
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Shimizu
authors.forename: Michio
authors.initials: M
authors.lastname: Shimizu
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yasumoto
authors.forename: Isamu
authors.initials: I
authors.lastname: Koyama
mesh_terms: D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis; D021441:Carcinoma, Pancreatic Ductal / Q000737:chemistry / Q000473:pathology* / Q000601:surgery; D002291:Carcinoma, Papillary / Q000737:chemistry / Q000473:pathology* / Q000601:surgery; D002471:Cell Transformation, Neoplastic / Q000473:pathology*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D010190:Pancreatic Neoplasms / Q000737:chemistry / Q000473:pathology* / Q000601:surgery; D016577:Pancreaticoduodenectomy; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor