A Case of Intraductal Papillary Mucinous Neoplasm Localized in the Dorsal Pancreas in a Patient with Pancreas Divisum

Tsutomu Kawaguchi, Tsuyoshi Itoh, Hidefumi Ueda, Yuuji Sasaki, Atsushi Tohma, Kenji Nakamura, Nobuaki Fuji, Takeshi Masaki* and Kazuyo Naito

Department of Surgery and Department of Clinical Pathology*, Kyoto Prefectural Yosanoumi Hospital

We report a rare case of intraductal papillary mucinous neoplasm (IPMN) localized in the dorsal pancreas in a patient with pancreas divisum. A 64-year-old man admitted for further examination of a cystic lesion in the pancreatic head was found in ultrasonography (US) and computed tomography (CT) to have a multilocular cystic lesion in the pancreas head and body 25 mm in diameter. Endoscopic retrograde cholangiopancreatography (ERCP) via the papilla of Vater and accessory papilla showed an enlarged dorsal pancreatic duct and multilocular cyst communicating to the duct in the pancreatic head and body, and the absence of a ventral pancreatic duct. Endoscopic ultrasonography showed a mural nodule in the multilocular cyst, yielding a diagnosis of branch type of IPMN with possible malignant components localized in the dorsal pancreas. We conducted subtotal stomach-preserving pancreaticoduodenectomy with D2 lymph node dissection. The pathological diagnosis of the resected specimen was IPM adenoma and pancreas divisum. Only 14 such cases have, to our knowledge, been reported in Japanese and English literature, we herein report our case with some discussion.

Key words
intraductal papillary mucinous neoplasm, pancreas divisum, dorsal pancreas

Reprint requests
Tsutomu Kawaguchi Department of Surgery, Kyoto Prefectural Yosanoumi Hospital
481 Otokoyama, Yosanocho, Yosagun, Kyoto, 629-2261 JAPAN

Accepted
March 25, 2009

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