Coexisting Pancreatic Ductal Adenocarcinomas Derived from and Concomitant with Intraductal Papillary Mucinous Neoplasm in a Case with Pancreatic Divisum

Abstract

We report a case of coexisting pancreatic ductal adenocarcinomas (PDACs) derived from intraductal papillary mucinous neoplasm (IPMN) and concomitant with IPMN in a patient with pancreatic divisum. A 73-year-old man visited our clinic for epigastralgia. Endoscopic retrograde pancreatography (ERP) showed a markedly dilated Wirsung duct and IPMN was diagnosed. ERP imaging from the accessory papilla duodeni showed that the Santrini duct continued to the main pancreatic duct and did not connect to the Wirsung duct. This observation was diagnosed as pancreatic divisum. Pancreatic duct stenosis was also found in the pancreatic body. The patient underwent pylorus-preserving pancreatoduodenectomy. Histological examination showed that PDAC derived from IPMN was present in the pancreas head and PDAC concomitant with IPMN was in the pancreas body. Based on our experience and a review of the literature, there is a need for careful preoperative examinations to select an appropriate surgical procedure for such a rare case with coexisting PDACs derived from and concomitant with IPMN.