title: [Synchronous malignant intraductal papillary mucinous neoplasms of the bile duct and pancreas requiring left hepatectomy and total pancreatectomy].
abstract: Intraductal papillary mucinous neoplasm of the bile duct (IPMN-B) and intraductal papillary mucinous neoplasm of the pancreas (IPMN-P) have striking similarities and are recognized as counterparts. However, simultaneous occurrence of IPMN-B and IPMN-P is extremely rare. A 66 year-old female presented with recurrent epigastric pain and fever. During the past 9 years, she had three clinical episodes related to intrahepatic duct stones and IPMN-P in the pancreas head and was managed by medical treatment. Laboratory test results at admission revealed leukocytosis (12,600/mm(3)) and elevated CA 19-9 level (1,200 U/mL). Imaging study demonstrated liver abscess in the Couinaud's segment 4, IPMN-B in the left lobe, and IPMN-P in the whole pancreas with suspicious malignant change. Liver abscess was drained preoperatively, followed by left lobectomy with bile duct resection and total pancreatectomy with splenectomy. On histologic examination, non-invasive intraductal papillary mucinous carcinoma arising from various degree of dysplastic mucosa of the liver and pancreas could be observed. However, there was no continuity between the hepatic and pancreatic lesions. This finding in our case supports the theory that double primary lesions are more likely explained by a diffuse IPMN leading to synchronous tumors arising from both biliary and pancreatic ducts rather than by a metastatic process. Herein we present a case of simultaneous IPMN of the bile duct and pancreas which was successfully treated by surgical management.
authors.affiliation: Hepatobiliary Surgery and Liver Transplantation, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwongil, Songpa-gu, Seoul 138-736, Korea.
authors.forename: Deok-Bog
authors.initials: DB
authors.lastname: Moon
authors.forename: Sung-Gyu
authors.initials: SG
authors.lastname: Lee
authors.forename: Dong-Hwan
authors.initials: DH
authors.lastname: Jung
authors.forename: Gil-Chun
authors.initials: GC
authors.lastname: Park
authors.forename: Yo-Han
authors.initials: YH
authors.lastname: Park
authors.forename: Hyung-Woo
authors.initials: HW
authors.lastname: Park
authors.forename: Myung-Hwan
authors.initials: MH
authors.lastname: Kim
authors.forename: Sung-Koo
authors.initials: SK
authors.lastname: Lee
authors.forename: Eun-Sil
authors.initials: ES
authors.lastname: Yu
authors.forename: Ji-Hoon
authors.initials: JH
authors.lastname: Kim
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D000231:Adenocarcinoma, Papillary / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D000368:Aged; D001650:Bile Duct Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D001653:Bile Ducts, Intrahepatic / Q000473:pathology; D018395:CA-19-9 Antigen / Q000032:analysis; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007964:Leukocytosis / Q000175:diagnosis; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed
chemical_list: D018395:CA-19-9 Antigen