Intraductal Papillary Mucinous Neoplasms of Pancreas: The Good, the Bad, and the Ugly

TL;DRAbstract

Case Report Intraductal papillary mucinous neoplasms (IPMN) arise from main pancreatic duct (MD-IPMN) and/or branch ducts (BD-IPMN), and are characterized by intraductal papillary proliferation of mucin-producing epithelial cells exhibiting various degrees of dysplasia.1 IPMNs have a potential for malignant transformation with a well-described adenoma carcinoma sequence. We present endoscopic images from 3 cases of IPMN: without dysplasia, with high-grade dysplasia, and with invasive carcinoma. The Good: A 62-year-old woman presented with bloating, unintended weight loss, loose stools, and a past history of heavy alcohol and tobacco use. Endoscopic ultrasound (EUS) showed chronic pancreatitis with but no mural nodules. Pancreatoscopy showed a widely patent papilla with gaping or “fish mouth” appearance (Figure 1) and diffusely dilated duct with mucous (Figure 2), suggestive of MD-IPMN. Intraductal biopsies showed inflammatory changes but no dysplasia. Recommendations were made per guid

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