Branch-duct Intraductal Papillary Mucinous Neoplasm with Rapidly Developing Intracystic Xanthogranulomatous Nodules

• Published in: Internal Medicine Vol. 62; no. 23; pp. 3489 - 3494
• Main Authors: Kitagawa, Sho, Ichihara, Shin, Omori, Yuko, Maeda, Chiho, Ono, Yusuke, Tahara, Munenori, Furukawa, Toru, Muraoka, Shunji, Miyakawa, Hiroyuki
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 01.12.2023; Japan Science and Technology Agency
• Subjects: Aged; Carcinoma, Pancreatic Ductal - complications; Carcinoma, Pancreatic Ductal - pathology; Carcinoma, Pancreatic Ductal - surgery; Case Report; Case reports; Cysts; droplet digital PCR; Humans; Internal medicine; intraductal papillary mucinous neoplasm; Male; Neoplasia; Nodules; Pancreas; Pancreatic Ducts - pathology; Pancreatic Intraductal Neoplasms - pathology; Pancreatic Neoplasms - complications; Pancreatic Neoplasms - diagnosis; Pancreatic Neoplasms - surgery; xanthogranulomatous nodule; xanthogranulomatous pancreatitis; xanthogranulomatous pancreatitis; xanthogranulomatous nodule; intraductal papillary mucinous neoplasm; droplet digital PCR; pancreas
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.0862-22

We herein report a case of a branch-duct intraductal papillary mucinous neoplasm (IPMN) with rapidly developing intracystic xanthogranulomatous nodules. A unilocular cystic lesion without a mural nodule was found in the pancreatic tail of a 69-year-old man. Ten months later, multiple mural nodules emerged unexpectedly within the cyst, and the patient underwent distal pancreatectomy. Based on immunohistochemical studies and a molecular analysis, we diagnosed him with branch-duct IPMN of the gastric immunophenotype. Fragility of the pancreatic duct mucosa and consequent exposure of the wall to pancreatic juice might have caused marked granulation nodule formation in the cyst lumen.