The natural history of recurrent metachronous intraductal papillary mucinous neoplasm imaged for 3 years after diagnosis

Abstract

The patient was a 77-year-old man who underwent distal pancreatectomy and splenectomy for intraductal papillary mucinous neoplasm (IPMN) at another institution 8 years previously. CT scan 7 snd 6 years previously showed no abnormalities. CT scan 3 years before revealed dilatation of the main pancreatic duct with multiple cystic lesions. Recurrent metachronous IPMN was suspected, and surgery was recommended but follow-up alone was conducted in accordance with the patient's wishes. CT 2 and 1 year previously showed enlargement of the cystic lesions. CT examination at presentation showed that multiple cystic lesions had become larger. Mural nodules were identified in the pancreatic body by endoscopic ultrasonography examination and remnant pancreatectomy performed. The patient's postoperative course was uneventful, and he was discharged 28 days postoperatively. The pathology results showed IPMN with high grade dysplasia, and metachronous recurrence diagnosed based on the absence of continuity with the previous lesion and multicentric pattern. This is a report of the natural history of metachronous recurrence after IPMN resection with imaging studies for 3 years.