title: Simultaneous intraductal papillary neoplasms of the bile duct and pancreas treated with chemoradiotherapy.
abstract: 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.
authors.affiliation: 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.
authors.forename: Roberto
authors.initials: R
authors.lastname: Valente
authors.forename: Gabriele
authors.initials: G
authors.lastname: Capurso
authors.forename: Paola
authors.initials: P
authors.lastname: Pierantognetti
authors.forename: Elsa
authors.initials: E
authors.lastname: Iannicelli
authors.forename: Matteo
authors.initials: M
authors.lastname: Piciucchi
authors.forename: Adriana
authors.initials: A
authors.lastname: Romiti
authors.forename: Paolo
authors.initials: P
authors.lastname: Mercantini
authors.forename: Alberto
authors.initials: A
authors.lastname: Larghi
authors.forename: Giulia Francesca
authors.initials: GF
authors.lastname: Federici
authors.forename: Viola
authors.initials: V
authors.lastname: Barucca
authors.forename: Maria Falchetto
authors.initials: MF
authors.lastname: Osti
authors.forename: Emilio
authors.initials: E
authors.lastname: Di Giulio
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ziparo
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Delle Fave