title: Concomitant pancreatic endocrine neoplasm and intraductal papillary mucinous neoplasm: a case report and literature review.
abstract: We report a case of concomitant pancreatic endocrine neoplasm (PEN) and intraductal papillary mucinous neoplasm (IPMN). A 74-year-old man had been followed-up for mixed-type IPMN for 10 years. Recent magnetic resonance images revealed an increase in size of the branch duct IPMN in the pancreas head, while the dilation of the main pancreatic duct showed minimal change. Although contrast-enhanced computed tomography and magnetic resonance imaging did not reveal any nodules in the branch duct IPMN, endoscopic ultrasound indicated a suspected nodule in the IPMN. A malignancy in the branch duct IPMN was suspected and we performed pylorus-preserving pancreatoduodenectomy with lymphadenectomy. The resected specimen contained a cystic lesion, 10 x 10 mm in diameter, in the head of the pancreas. Histological examination revealed that the dilated main pancreatic duct and the branch ducts were composed of intraductal papillary mucinous adenoma with mild atypia. No evidence of carcinoma was detected in the specimen. Incidentally, a 3-mm nodule consisting of small neuroendocrine cells was found in the main pancreatic duct. The cells demonstrated positive staining for chromogranin A, synaptophysin, and glucagon but negative staining for insulin and somatostatin. Therefore, the 3-mm nodule was diagnosed as a PEN. Since the mitotic count per 10 high-power fields was less than 2 and the Ki-67 index was less than 2%, the PEN was pathologically classified as low-grade (G1) according to the 2010 World Health Organization (WHO) criteria. Herein, we review the case and relevant studies in the literature and discuss issues related to the synchronous occurrence of the relatively rare tumors, PEN and IPMN.
authors.affiliation: Department of Surgery, School of Medicine, Shinjuku, Tokyo, Japan.
authors.forename: Yoshie
authors.initials: Y
authors.lastname: Kadota
authors.forename: Masahiro
authors.initials: M
authors.lastname: Shinoda
authors.forename: Minoru
authors.initials: M
authors.lastname: Tanabe
authors.forename: Hanako
authors.initials: H
authors.lastname: Tsujikawa
authors.forename: Akihisa
authors.initials: A
authors.lastname: Ueno
authors.forename: Yohei
authors.initials: Y
authors.lastname: Masugi
authors.forename: Go
authors.initials: G
authors.lastname: Oshima
authors.forename: Ryo
authors.initials: R
authors.lastname: Nishiyama
authors.forename: Masayuki
authors.initials: M
authors.lastname: Tanaka
authors.forename: Kisho
authors.initials: K
authors.lastname: Mihara
authors.forename: Yuta
authors.initials: Y
authors.lastname: Abe
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yagi
authors.forename: Minoru
authors.initials: M
authors.lastname: Kitago
authors.forename: Osamu
authors.initials: O
authors.lastname: Itano
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Kawachi
authors.forename: Koichi
authors.initials: K
authors.lastname: Aiura
authors.forename: Akihiro
authors.initials: A
authors.lastname: Tanimoto
authors.forename: Michiie
authors.initials: M
authors.lastname: Sakamaoto
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kitagawa
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D002291:Carcinoma, Papillary / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D004701:Endocrine Gland Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D019160:Endosonography; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009378:Neoplasms, Multiple Primary / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D016577:Pancreaticoduodenectomy; D011379:Prognosis; D012196:Review Literature as Topic; D014057:Tomography, X-Ray Computed