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CASE PRESENTATION

2010-11-12

R3

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CASE M/68

10131941

Present illness

2007. 11: abdominal distension and pain

2008. 4 : fever, RLQ pain

2009. 6: Total Bil. 1.8 Direct Bil. 0.4

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2007.11. abdomen pelvis CT

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2008. 4. appendix CT

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2009. 6. GB billiary CT

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2009. 6. MRCP

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OP name:

pylorus-preserving pancreatoduodenectomy:

Intraductal papillary-mucinous neoplasm

with moderate dysplasia(Intraductal papillary-mucinous neoplasm of borderline

malignancy)

1) Location of tumor: head2) Size of tumor: 1.2x0.8cm3) Gross type: cystic4) Bile duct: no invasion5) Duodenum: no invasion6) Surgical margins: free from tumor7) Lymph node: No metastasis in 14 lymph nodes8) Angiolymphatic invasion: not identified9) Venous invasion: not identified10) Perineural invasion: not identified11) No ovarian-type stroma

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2009. 7. F/up CT

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2010. 2. F/up CT

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2010. 5. F/up CT

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Op name:

Appendix, appendectomy

Diagnosis

Mucinous cystadenoma

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Concomitant

IPMN of pancreas

&mucinous cystadenoma

of appendix

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Pancreas and appendiceal tumor

in this case: independent, primary neoplasms

Different pathology Distant organ

No reported case

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IPMN of pancreas

Spectrum of proliferation of pancreaticductal epithelium characterized by

Intraductal papillary growth

Produces an excessive amount of mucinCystic dilatation of pancreatic duct

Elderly (60 - 80 years of age)

M>F

Dx of choice: ERCP communicating duct between main pancreatic duct and dilated

lesion

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Types of IPMNa. Branch duct type

: cystic dilation of branch

duct in uncinate process

b. Main duct type: diffuse or segmental

dilatation of main ducthighest malignant potential

c. Combined type

: dilatation of main duct

and branch ducts

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CT Findingsa. Branch duct type

b. Main duct type

c. Combined type

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Mucinous cystadenoma

of appendix Appendix mucocele

Chronic cystic dilatation of appendiceal lumencaused by an accumulation of mucin

Incidence 0.2-0.3% of appendectomy

Four histologic subtypes: Simple mucocele

Focal or diffuse mucosal hyperplasia

Mucinous cystadenoma: m/c type

Mucinous cystadenocarcinoma pseudomyxoma peritonei

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Mucinous cystadenoma

of appendix M/C clinical manifestation

Palpable mass in RLQ +/- pain

Imaging finding

Ultrasound: dilated tubular shape structure

(with cystic content or echoic layering)

CT:

-Dilated tubular shape structure at tip of cecum-Luminal diameter > 1.3 cm

-Mural calcification

-Intraluminal gas or air-fluid level

; superimposed infection

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Associated with colonic cancer

in 19.5%

21.4%

Associated with mucinous tumor of ovary

Associated with stomach cancer

Appediceal mucocele

and associated

other organ disease

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