Intraductal Papillary Mucinous Neoplasm with Pancreatogastric Fistula

Takahashi, Hideaki; Adachi, Yasushi; Nakahara, Kazunari; Kikuchi, Takefumi; Mitsuya, Hiroaki; Nakamura, Masahiro; Yoshida, Yukinari; Kato, Yasuo; Ishii, Yoshifumi; Endo, Takao

doi:10.2169/internalmedicine.5889-20

Cited by 3 publications

(2 citation statements)

References 14 publications

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“…We excluded articles in which the number of affected organs in each fistula was unavailable. Ultimately, we found 54 articles, including 3 retrospective studies, [7–9] 36 case reports, [10–46] and 15 brief imaging articles [47–60] (Fig. 3).…”

Section: Discussionmentioning

confidence: 99%

Fistula formation into other organs secondary to intraductal papillary mucinous neoplasm of the pancreas: A case report and literature review

et al. 2023

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Introduction: Fistula formation from intraductal papillary mucinous neoplasm (IPMN) of the pancreas is uncommon; however, IPMN penetrating various organs has been increasingly reported. To date, there is a lack of literature reviewing recent reports and the clinicopathologic details of IPMN with fistula formation are still poorly understood. Methods: This study describes the case of a 60-year-old woman presenting with postprandial epigastric pain and diagnosed with main-duct (MD) IPMN penetrating to the duodenum, and presents comprehensive literature review of IPMN with fistulae. A literature review was performed using PubMed for all articles in English using predetermined search terms, including (fistula or fistulization), (pancreas or pancreatic or pancreato or pacreatico), (intraductal papillary mucinous), and (neoplasm or tumor or carcinoma or cancer). Results: A total of 83 cases and 119 organs were identified in 54 articles. Affected organs were as follows: the stomach (34%), duodenum (30%), bile duct (25%), colon (5%), small intestine (3%), spleen (2%), portal vein (1%), and chest wall (1%). Fistula formation into multiple organs was detected in 35% of cases. Approximately one-third of the cases had tumor invasion around the fistula. MD and mixed type IPMN accounted for 82% of cases. IPMN with high-grade dysplasia or invasive carcinoma were over three times more common than IPMN without these components. Discussion and conclusion: Based on the pathological examination of the surgical specimen, this case was diagnosed of MD-IPMN with invasive carcinoma and mechanical penetration or autodigestion was considered as the mechanism of fistula formation. Given the high risk of malignant transformation and intraductal dissemination of the tumor cells, aggressive surgical strategies, such as total pancreatectomy, should be recommended to achieve complete resection for MD-IPMN with fistula formation.

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Section: Discussionmentioning

confidence: 99%

Fistula formation into other organs secondary to intraductal papillary mucinous neoplasm of the pancreas: A case report and literature review

et al. 2023

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“…Pathologically, MD-IPMN has a substantial potential for progression into an aggressive invasive carcinoma ( 7 ). Two factors have been considered for the pathogenesis of fistula formation in IPMN, i.e., invasive penetration of cancer cells and mechanical penetration caused by elevated pressure in the mucus-filled pancreatic duct ( 8 , 32 ). The first mechanism is seen in malignant tumors, while the second one is mostly seen in benign tumors; nevertheless, a large malignant IPMN would mechanically fistulate into adjacent organs by the effect of direct contact and high pressure on the surrounding organs.…”

Section: Discussionmentioning

confidence: 99%

Pancreatico-gastric fistula arising from IPMN associated with ductal adenocarcinoma of the pancreas: a case report and a literature review

2023

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IntroductionAn intraductal papillary mucinous neoplasm (IPMN) is a potentially malignant cystic tumor that is characterized by an excessive papillary proliferation of mucin-producing epithelial cells. The IPMN usually exhibits different degrees of dysplasia and is accompanied by cystic dilation of the main pancreatic duct (MPD) or side branch. We report a case of an IPMN that has penetrated the stomach and has differentiated into an adenocarcinoma.Case presentationA 69-year-old female, suffering from chronic pancreatitis of unknown etiology, visited our outpatient clinic with complaints of sudden weight loss, diarrhea, and abdominal pain. She underwent several examinations to evaluate the reasons for her sudden onset of symptoms. A gastroscopy showed an ulcerated lesion covered with mucus. CT and magnetic resonance cholangiopancreatography images revealed that the MPD was dilated to 1.3 cm with a fistula formation between the MPD and the stomach. After a multidisciplinary discussion of this case, a total pancreatectomy was proposed. An en bloc total pancreatectomy with gastric wedge resection including the fistula together with splenectomy was carried out. A Roux-en-Y choledochojejunostomy and gastrojejunostomy were performed. Histology results revealed the association of IPMN with invasive carcinoma.DiscussionMany reports on IPMN of the pancreas have been published recently. Fistula formation between IPMN and adjacent organs is possible. Given the CT and endoscopic ultrasonography findings, it shows that in our case a main duct IPMN (MD-IPMN) formed a pancreatico-gastric fistula. We point out that the adherence of invasive cancer cells contributed to the fistula formation between the pancreas and the stomach.ConclusionThis case report provides evidence for the possibility of IPMN becoming complicated with pancreatico-gastric fistula. Thus, we suggest that surgical resection should be considered in the case of MD-IPMN because of its high propensity for malignant transformation.

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A pancreaticogastric fistula related to intraductal papillary mucinous neoplasm of the pancreas developed during follow‐up: A case report and literature review

Ding,

Yang,

Yang

et al. 2024

J of Digest Diseases

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Intraductal Papillary Mucinous Neoplasm with Pancreatogastric Fistula

Cited by 3 publications

References 14 publications

Fistula formation into other organs secondary to intraductal papillary mucinous neoplasm of the pancreas: A case report and literature review

Fistula formation into other organs secondary to intraductal papillary mucinous neoplasm of the pancreas: A case report and literature review

Pancreatico-gastric fistula arising from IPMN associated with ductal adenocarcinoma of the pancreas: a case report and a literature review

A pancreaticogastric fistula related to intraductal papillary mucinous neoplasm of the pancreas developed during follow‐up: A case report and literature review

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