Premium
Intraductal papillary adenoma: Usefulness of magnetic resonance cholangiopancreatography in the diagnosis of cystic branch‐duct dilatation of the pancreas
Author(s) -
Mizuno Shugo,
Yano Takashi,
Isaji Shuji,
Nakagawa Shunichi,
Yokoi Hajime,
Kawarada Yoshifumi
Publication year - 1997
Publication title -
journal of hepato‐biliary‐pancreatic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 0944-1166
DOI - 10.1007/bf02488985
Subject(s) - medicine , magnetic resonance cholangiopancreatography , pancreas , endoscopic retrograde cholangiopancreatography , radiology , pancreatic duct , lesion , magnetic resonance imaging , choledochal cysts , adenoma , endoscopic ultrasound , cyst , adenocarcinoma , pathology , cancer , gastroenterology , pancreatitis
A 70‐year‐old woman with gastric cancer was referred to our hospital for further evaluation of a cystic mass in the head of the pancreas. Endoscopic ultrasonography (EUS) showed a mural nodule in the cystic mass. Endoscopic retrograde cholangio pancreatography (ERCP) revealed a cystic lesion with a filling defect caused by obstruction with mucus. Magnetic resonance cholangiopancreatography (MRCP) allowed visualization of the entire configuration of the cystic lesion despite the presence of mucus. Pancreatic juice was positive for K‐ ras point mutation. Pancreatoduodenectomy was performed, with a diagnosis of intraductal papillary adenoma or adenocarcinoma with gastric cancer. Pancreatography of the resected specimen showed a cystic lesion in the uncinate process, consistent with the MRCP findings. Histological examination revealed an intraductal papillary adenoma. MRCP is very useful for demonstrating the total configuration of cystic lesions and is not impeded by impacted mucin. Nevertheless, because of its lower spatial resolution, this noninvasive modality is of limited value in detecting mural nodules. At present, therefore, surgical indications for cystic lesion of the pancreas should be determined by comprehensively analyzing: size and sequential changes in size of the cyst; presence of mural nodules, cytologic examination for presence of malignant cells, and/or K‐ ras point mutation in pure pancreatic juice.