A Case of Minute Intraductal Papillary Mucinous Tumor of the Pancreas Presenting with Recurrent Acute Pancreatitis

Intraductal papillary mucinous tumors (IPMT) of the pancreas is a lesion consisting of mucin-producing cells with neoplastic potential. This unique group of tumors is characterized by duct ectasia, mucin hypersecretion, often extensive papillary intraductal growth, varying degrees of cytologic atypia, and relatively indolent growth. Now IPMT of the pancreas also includes intraductal papillary neoplasms that do not hypersecrete mucin. The clinical presentation of IPMT of the pancreas is characterized by chronic or recurrent attacks of abdominal discomfort often in association with low level pancreatic enzyme elevations. The episodes of pancreatitis due to IPMT of the pancreas are mild in severity. Recently, we was experienced a case of a minute IPMT causing repeated bouts of acute pancreatitis in a 75 year-old man. An endoscopic retrograde pancreatogram revealed a filling defect at the neck of the main pancreatic duct. A near-total pancreatectomy was performed and a minute (3×7 mm) IPMT of borderline malignancy was found in a branch duct at the pancreatic head. Surprisingly, despite the resective surgery the patient died of carcinomatosis. 8.5 months after the operation. This case of a minute but aggressive IPMT of the pancreas is herein reported with a review of the relevant literature. (Korean J Gastrointest Endosc 2000;20:481 -485)ope