Intraductal papillary mucinous neoplasm - main duct type

Case contributed by Mostafa El-Feky

Presentation

Abdominal pain.

Patient Data

Age: 70 years
Gender: Male

CT abdomen with contrast

ct

The pancreas shows diffuse dilatation of the main pancreatic duct and its branches till the pancreatic head reaching 13 mm in diameter, with no evident underlying masses noted. This is associated with hypoenhancing enlarged edematous pancreatic parenchyma, surrounded by fat stranding. It is abutting the greater curvature of the stomach. No enhancing nodules at the pancreatic duct could be noted. Multiple small reactive peri-pancreatic lymph nodes are noted.

Normal caliber of the CBD. No intra or extra hepatic biliary dilatation.

Bilateral renal simple cortical cysts are also noted.

Case Discussion

Features are raising the possibility of IPMN likely complicated by an element of pancreatitis. Dilated pancreatic duct is also seen in chronic pancreatitis and it is difficult to distinguish between both entities on account of the dilated duct, the presence of calcifications in chronic pancreatitis may help and both can be complicated by repeated acute exacerbations of pancreatitis. IPMNs are one of a number of mucinous tumors of the pancreas with malignant potential.

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