Giant mixed-type intraductal papillary mucinous neoplasm of the pancreatic body and tail with high-grade dysplasia: a case report
Wail AlqattaIntroduction:
Intraductal papillary mucinous neoplasm (IPMN) is a mucin-producing pancreatic epithelial neoplasm with recognized malignant potential. Giant symptomatic lesions are rare and present significant diagnostic and surgical challenges. Management is guided by risk stratification based on high-risk stigmata and worrisome features.
Case presentation:
A 48-year-old woman presented with a several-month history of progressive epigastric, left upper quadrant, and left flank pain associated with intermittent nausea, vomiting, and mild weight loss. Laboratory investigations, including carbohydrate antigen 19-9 and carcinoembryonic antigen, were normal. Abdominal ultrasonography and computed tomography angiography (CTA) demonstrated a 12 × 10 cm mixed solid-cystic lesion arising from the pancreatic body and tail with compression of the stomach, splenic vessels, and the left adrenal gland. Following appropriate preoperative vaccination against overwhelming post-splenectomy infection, the patient underwent exploratory laparotomy with en bloc distal pancreatosplenectomy. Despite dense inflammatory adhesions and marked local mass effect, complete oncologic resection with negative margins was achieved. The postoperative course was uneventful, and histopathology confirmed mixed-type IPMN with high-grade dysplasia without invasive carcinoma. At 6 months, the patient remained asymptomatic with no evidence of recurrence.
Discussion:
A giant mixed-type IPMN may mimic more aggressive pancreatic neoplasms, while normal serum tumor markers do not exclude advanced dysplastic disease. Careful radiological assessment, multidisciplinary planning, and timely oncologic resection are essential for optimal outcomes.
Conclusion:
This case highlights that a large symptomatic mixed-type IPMN with high-grade dysplasia may occur despite normal serum tumor markers and without invasive carcinoma. Complete surgical resection can prevent malignant progression and achieve favorable short-term outcomes.