scholarly journals Detection of High-Grade Pancreatic Intraepithelial Neoplasia without Morphological Changes of the Main Pancreatic Duct over a Long Period: Importance for Close Follow-Up for Confirmation

Oncology ◽  
2017 ◽  
Vol 93 (1) ◽  
pp. 81-86
Author(s):  
Kentaro Yamao ◽  
Mamoru Takenaka ◽  
Atsushi Nakai ◽  
Shunske Omoto ◽  
Ken Kamata ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Morphological Changes ◽  
Intraepithelial Neoplasia ◽  
High Grade ◽  
Pancreatic Intraepithelial Neoplasia ◽  
Long Period

scholarly journals A Case of Pancreatic Intraepithelial Neoplasia That Was Difficult to Diagnose Preoperatively

2015 ◽  
Vol 8 (1) ◽  
pp. 30-36 ◽  
Author(s):  
Hiroyuki Ito ◽  
Yoshiaki Kawaguchi ◽  
Yohei Kawashima ◽  
Atsuko Maruno ◽  
Masami Ogawa ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Cystic Lesion ◽  
Precancerous Lesion ◽  
Intraepithelial Neoplasia ◽  
The Body ◽  
Pancreatic Ductal Carcinoma ◽  
Pancreatic Intraepithelial Neoplasia ◽  
Multiple Imaging

A 63-year-old female patient presented to a local physician with pain in her back and epigastric region. An abdominal computed tomography (CT) scan revealed a pancreatic tumor, and the patient was referred to our hospital. Multiple imaging studies that included ultrasonography (US), CT, MRI, and endoscopic US revealed a cystic lesion 3-4 cm in size with node-like projections in the body of the pancreas. The distal main pancreatic duct was also found to be dilated. Endoscopic retrograde pancreatography revealed an irregular stenosis of the main pancreatic duct proximal to the cystic lesion, and malignancy was suspected. The patient was preoperatively diagnosed with pancreatic ductal carcinoma concomitant with intraductal papillary mucinous carcinoma, and a distal pancreatectomy was performed. Rapid pathological diagnosis during surgery revealed positive surgical margins for pancreatic intraepithelial neoplasia (PanIN). Further resection was performed twice, her surgical margin was positive and total pancreatectomy was ultimately conducted. Histopathological findings revealed diffuse microinvasive cancerous lesions corresponding to PanIN-2 (moderate dysplasia) to PanIN-3 (carcinoma in situ) throughout the pancreas. PanIN involves microlesions of the ductal epithelium that may precede pancreatic cancer. Ascertaining changes in PanIN using images provided by diagnostic modalities such as CT and US is challenging. Ductal stenosis and distal cystic lesions resulting from atrophy and fibrosis of pancreatic tissue were noted around PanIN. Considering the possibility of PanIN, a precancerous lesion during differential diagnosis will help to improve early detection and prognosis for patients with pancreatic cancer.

scholarly journals A hypoechoic, tumor-like lesion in the pancreatic head and neck on endoscopic ultrasonography may be due to a high-grade pancreatic intraepithelial neoplasia/carcinoma in situ

2021 ◽  
pp. 50
Author(s):  
◽  
◽  
◽  
Keyword(s):  
Head And Neck ◽  
Pancreatic Duct ◽  
Carcinoma In Situ ◽  
Pancreatic Head ◽  
Intraepithelial Neoplasia ◽  
Ductal Adenocarcinoma ◽  
High Grade ◽  
Pancreatic Intraepithelial Neoplasia ◽  
Cytologic Examination

High-grade pancreatic intraepithelial neoplasia (HG PanIN)/carcinoma in situ (CIS) in the pancreatic body and tail can induce parenchymal atrophy through chronic inflammatory changes presenting as a Hypoechoic area on EUS (Hypocho) or focal pancreatic parenchymal atrophy (FPPA) on computed tomography (CT) and magnetic resonance imaging (MRI). We herein discussed two patients with a hypoechoic area in the pancreatic head and neck on EUS resembling pancreatic ductal adenocarcinoma (PDAC). The lesions consisted of dense fibrosis and fat infiltration with pancreatic parenchymal atrophy around the HG PanIN/CIS in the main pancreatic duct (MPD), which penetrated the lesion and showed mild stenosis and upstream dilation. CT and MRI were unable to visualize the lesions. A specimen was obtained from one lesion by fine-needle aspiration under EUS (EUS-FNA) guidance for histopathological and cytological analysis, but the tests returned negative for adenocarcinoma. However, serial pancreatic-juice aspiration cytologic examination (SPACE) revealed adenocarcinoma in both lesions, prompting surgical resection. Histopathological examination revealed non-invasive HG PanIN/CIS in the MPD surrounded by dense fibrosis and fat deposition in the area of parenchymal atrophy. The CIS was restricted to the area of parenchymal atrophy.These two cases are noteworthy in illustrating a hypoechoic area appearing on EUS as a tumor-like lesion resembling PDAC. EUS-FNA has recently been used histopathologically to diagnose a pancreatic lesion. However, in the present and similar cases, EUS-FNA can only reveal secondary changes due to CIS unless the pancreatic duct covered by the CIS is accidentally punctured. We should bear in mind that CIS can appear as a hypoechoic area resembling PDAC on EUS, and that SPACE is the best method for diagnosing CIS in such cases.

Pancreatic intraepithelial neoplasia-3 with localized acute pancreatitis in the main pancreatic duct

2013 ◽  
Vol 6 (2) ◽  
pp. 164-168 ◽  
Author(s):  
Takaho Okada ◽  
Fuyuhiko Motoi ◽  
Atsushi Kanno ◽  
Atsushi Masamune ◽  
Kazuyuki Ishida ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Intraepithelial Neoplasia ◽  
Pancreatic Intraepithelial Neoplasia

A case of pancreatic intraepithelial neoplasia detected by pancreatic duct dilation

2021 ◽  
Vol 99 (1) ◽  
pp. 146-148
Author(s):  
Hironori Tanei ◽  
Reina Tanaka ◽  
Takayoshi Tsuchiya ◽  
Kentaro Ishii ◽  
Ryosuke Tonozuka ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Intraepithelial Neoplasia ◽  
Pancreatic Intraepithelial Neoplasia
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