간좌엽 및 췌전절제 수술이 필요했던 간내담관 및 췌장관 내에 발생한 동시성 유두모양 점액선암

• Published in: The Korean journal of gastroenterology Vol. 63; no. 2; pp. 129 - 133
• Main Authors: 문덕복, Deok Bog Moon, 이승규, Sung Gyu Lee, 정동환, Dong Hwan Jung, 박길춘, Gil Chun Park, 박요한, Yo Han Park, 박형우, Hyung Woo Park, 김명환, Myung Hwan Kim, 이성구, Sung Koo Lee, 유은실, Eun Sil Yu, 김지훈, Ji Hoon Kim
• Format: Journal Article
• Language: Korean
• Published: 대한소화기학회 01.02.2014
• Subjects: Bile duct; Malignant intraductal papillary mucinous neoplasms; Pancreas; Simultaneous; 내과학
• ISSN: 1598-9992; 2233-6869

Intraductal papillary mucinous neoplasm of the bile duct (IPMN-B) and intraductal papillary mucinous neoplasm of the pancreas (IPMN-P) have striking similarities and are recognized as counterparts. However, simultaneous occurrence of IPMN-B and IPMN-P is extremely rare. A 66 year-old female presented with recurrent epigastric pain and fever. During the past 9 years, she had three clinical episodes related to intrahepatic duct stones and IPMN-P in the pancreas head and was managed by medical treatment. Laboratory test results at admission revealed leukocytosis (12,600/mm3) and elevated CA 19-9 level (1,200 U/mL). Imaging study demonstrated liver abscess in the Couinaud`s segment 4, IPMN-B in the left lobe, and IPMN-P in the whole pancreas with suspicious malignant change. Liver abscess was drained preoperatively, followed by left lobectomy with bile duct resection and total pancreatectomy with splenectomy. On histologic examination, non-invasive intraductal papillary mucinous carcinoma arising from various degree of dysplastic mucosa of the liver and pancreas could be observed. However, there was no continuity between the hepatic and pancreatic lesions. This finding in our case supports the theory that double primary lesions are more likely explained by a diffuse IPMN leading to synchronous tumors arising from both biliary and pancreatic ducts rather than by a metastatic process. Herein we present a case of simultaneous IPMN of the bile duct and pancreas which was successfully treated by surgical management. (Korean J Gastroenterol 2014;63:129-133)