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<p>Recurrence of intraductal papillary mucinous neoplasms (IPMNs) in the remnant pancreas after surgery is a significant clinical challenge. A 68-year-old woman was incidentally found to have a 50-mm mixed-type intraductal papillary mucinous carcinoma (IPMC) in the pancreatic head during a health check. She underwent subtotal stomach-preserving pancreaticoduodenectomy with pancreatogastrostomy. Pathology revealed intestinal-type IPMC (pStage IA) with venous invasion and negative margins. Adjuvant oral S-1 chemotherapy was administered for six months. Eighteen months later, she developed rapid increases in HbA1c and tumor markers. Computed tomography showed 8-mm main pancreatic duct dilation in the remnant pancreas. Upper gastrointestinal endoscopy revealed a papillary tumor extending into the gastric mucosa, and biopsy confirmed adenocarcinoma. She was diagnosed with recurrent IPMC in the remnant pancreas and underwent total pancreatectomy with splenectomy. Intraoperative gastric endoscopy determined the extent of gastric wall resection. Postoperative chylous leakage occurred but resolved, and she was discharged on day 26. Pathology revealed non-invasive gastric-type IPMC, distinct from the intestinal-type lesion in the initial surgery. This case represents a rare metachronous recurrence of gastric-type IPMC following resection of intestinal-type IPMC, emphasizing the need for vigilant long-term surveillance and awareness of potential histologic subtype changes.</p>

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A case of total remnant pancreas resection performed for gastric-type IPMC after pancreaticoduodenectomy for intestinal-type IPMC

  • 期刊论文

  • 发表日期：

    2026年1月5日

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  • Yusuke Yaoita,
  • Mitsuru Yanagaki,
  • Taro Sakamoto,
  • Kenei Furukawa,
  • Koichiro Haruki,
  • Yoshihiro Shirai,
  • Michinori Matsumoto,
  • Masashi Tsunematsu,
  • Tomohiko Taniai,
  • Toru Ikegami

摘要

Recurrence of intraductal papillary mucinous neoplasms (IPMNs) in the remnant pancreas after surgery is a significant clinical challenge. A 68-year-old woman was incidentally found to have a 50-mm mixed-type intraductal papillary mucinous carcinoma (IPMC) in the pancreatic head during a health check. She underwent subtotal stomach-preserving pancreaticoduodenectomy with pancreatogastrostomy. Pathology revealed intestinal-type IPMC (pStage IA) with venous invasion and negative margins. Adjuvant oral S-1 chemotherapy was administered for six months. Eighteen months later, she developed rapid increases in HbA1c and tumor markers. Computed tomography showed 8-mm main pancreatic duct dilation in the remnant pancreas. Upper gastrointestinal endoscopy revealed a papillary tumor extending into the gastric mucosa, and biopsy confirmed adenocarcinoma. She was diagnosed with recurrent IPMC in the remnant pancreas and underwent total pancreatectomy with splenectomy. Intraoperative gastric endoscopy determined the extent of gastric wall resection. Postoperative chylous leakage occurred but resolved, and she was discharged on day 26. Pathology revealed non-invasive gastric-type IPMC, distinct from the intestinal-type lesion in the initial surgery. This case represents a rare metachronous recurrence of gastric-type IPMC following resection of intestinal-type IPMC, emphasizing the need for vigilant long-term surveillance and awareness of potential histologic subtype changes.