A case of minute intraductal papillary mucinous tumor of the pancreas presenting with recurrent acute pancreatitis

Intraductal papillary mucinous tumor (IPMT) of the pancreas, a lesion consi sting of mucin-producing cells with neoplastic potential, is characterized by duct ectasia, mucin hypersecretion, often extensive papillary intraducta l growth, varying degrees of cytologic atypia, and relatively indolent grow th. The clinical presentation of IPMT of the pancreas is characterized by c hronic or recurrent attacks of abdominal discomfort often in association wi th low level pancreatic enzyme elevations. Less commonly these lesions may be detected as asymptomatic radiographic abnormalities. Interestingly, a ca se of a minute IPMT (2 mm in height and 7 mm in length, adenoma) in the mai n pancreatic duct presenting with acute pancreatitis in a 55 year-old man h as been reported in the Japanese literature. Recently, we also experienced a case of a minute IPMT in a branch pancreatic duct causing repeated bouts of acute pancreatitis in a 75 year-old man. A filling defect at the neck of the main pancreatic duct seen on an endoscopic retrograde pancreatogram pe rformed after recovery of the second attack of acute pancreatitis led the p atient to undergo an exploratory laparotomy. After a near-total pancreatect omy was carried our, a minute (3 X 7 mm) IPMT of borderline malignancy was discovered in a branch duct at the head portion near the pancreatic neck wi thout any lesions in the main pancreatic duct. Surprisingly, despite the re sective surgery the patient died of carcinomatosis 8.5 months after the ope ration. We herein report a case of a minute but aggressive IPMT of the panc reas with a review of the literature.