title: Intraductal papillary-mucinous adenocarcinoma in the remnant pancreas after pancreatoduodenectomy for cancer of Vater's papilla associated with intraductal papillary-mucinous adenoma.
abstract: A 72-year-old woman, who had undergone pylorus-preserving pancreatoduodenectomy 3 years before for cancer of Vater's papilla associated with a branch-type intraductal papillary-mucinous adenoma (IPMA), developed dilatation of the main duct and a nodular lesion in the remnant pancreas. Total pancreatectomy was performed, which revealed that the lesion was intraductal papillary-mucinous adenocarcinoma (IPMC) with minimal invasion, suggesting the metachronous multicentric occurrence of this intraductal papillary-mucinous neoplasm (IPMN). Because there were no malignant cells at the pancreaticojejunostomy, and because the histological appearance of the main-duct IPMC was different from that of the IPMA in the primary specimen, the main-duct IPMC was thought to be of different origin from the IPMA. These findings suggest that careful surveillance of the gastrointestinal tract and careful follow up are necessary for IPMN, because an IPMN could be associated with other gastrointestinal tract malignancies.
authors.affiliation: Department of Gastroenterological Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryocho, Aobaku, Sendai, 980-8574, Japan.
authors.forename: Masaharu
authors.initials: M
authors.lastname: Ishida
authors.forename: Shinichi
authors.initials: S
authors.lastname: Egawa
authors.forename: Naoaki
authors.initials: N
authors.lastname: Sakata
authors.forename: Yukio
authors.initials: Y
authors.lastname: Mikami
authors.forename: Fuyuhiko
authors.initials: F
authors.lastname: Motoi
authors.forename: Tadayoshi
authors.initials: T
authors.lastname: Abe
authors.forename: Shoji
authors.initials: S
authors.lastname: Fukuyama
authors.forename: Makoto
authors.initials: M
authors.lastname: Sunamura
authors.forename: Toru
authors.initials: T
authors.lastname: Furukawa
authors.forename: Michiaki
authors.initials: M
authors.lastname: Unno
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000473:pathology / Q000601:surgery*; D000368:Aged; D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D003138:Common Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D016577:Pancreaticoduodenectomy; D014057:Tomography, X-Ray Computed