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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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