title: Natural history of branch-duct intraductal papillary mucinous neoplasms of the pancreas: a case report.
abstract: BACKGROUND
  The natural history of incidental branch-duct intraductal papillary mucinous neoplasm of the pancreas is still unknown.
  
  
  METHODS
  The case of a 74-year-old man who had been diagnosed 14 years previously with an incidental branch-duct intraductal papillary mucinous neoplasm of the pancreatic head, 30 mm in size, without mural nodules and dilatation of the main pancreatic duct is herein reported. After an exploratory laparotomy at the time of diagnosis (when he was 60 year-old), the patient was enrolled in a surveillance program. Fourteen years after the diagnosis, the cystic lesion showed an increase in size, Wirsung duct dilatation and the presence of several mural nodules. A total pancreatectomy was performed and a diagnosis of mixed-intraductal papillary mucinous neoplasm diffused throughout the entire pancreas with high grade dysplasia, and a micro-invasive carcinoma (<1 mm) of the pancreatic head was reached.
  
  
  CONCLUSIONS
  The present case confirmed that the natural history of branch-duct intraductal papillary mucinous neoplasms is unpredictable. Thus, an appropriate surveillance program is required for prompt identification of the signs predictive of a malignant transformation of branch-duct intraductal papillary mucinous neoplasms. In high-volume centers, surgery should seriously be considered in young patients who are fit for surgery.
authors: Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, S. Orsola-Malpighi Hospital. Bologna, Italy. riccardo.casadei@aosp.bo.it.
authors: Riccardo
authors: R
authors: Casadei
authors: Claudio
authors: C
authors: Ricci
authors: Marielda
authors: M
authors: D'Ambra
authors: Giovanni
authors: G
authors: Taffurelli
authors: Caterina C
authors: CC
authors: Zingaretti
authors: Carlo A
authors: CA
authors: Pacilio
authors: Lucia
authors: L
authors: Calculli
authors: Nico
authors: N
authors: Pagano
authors: Francesco
authors: F
authors: Minni
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D002291:Carcinoma, Papillary / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods; D010183:Pancreatic Ducts / Q000473:pathology* / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome