Recurrent intraductal papillary mucinous neoplasms of the pancreas mimicking ampullary cancer

Authors Masataka Hayashi, Kenjiro Date, Tomoko Kodata, Akihiro Yamasuji, Kou Fukumori, Koji Tamura, Naoki Maehara.


Although several studies have reported that some patients developed metachronous/recurrent intraductal papillary mucinous neoplasms (IPMNs) after partial pancreatectomy, recurrence of IPMN mimicking ampullary cancer is extremely rare. We report the case of a 62-year-old man who developed recurrent IPMN mimicking ampullary cancer. Every 3-6 months, the patient had received surveillance with computed tomography after distal pancreatectomy for IPMN, high-grade, pancreatobiliary type. However, a villous tumor at the major duodenal papilla was found incidentally by upper gastrointestinal endoscopy 2 years and 3 months after initial surgery, and the biopsy result was adenocarcinoma. Endoscopic ultrasonography showed a tumor at the periampullary lesion; however, the origin of the tumor could not be determined definitively. Remnant total pancreatectomy was performed, and the histological diagnosis revealed IPMN, high-grade, pancreatobiliary type. Some patients develop recurrent IPMN mimicking ampullary cancer; thus, careful surveillance for periampullary lesions as well as remnant pancreas should be performed.

Keywords Intraductal papillary neoplasm of the pancreas, recurrent, surveillance, endoscopic ultrasonography, ampullary tumor

Ann Gastroenterol 2020; 33 (5): 536-539

Case Report