Pancreatico-duodenectomy (Whipple procedure)

Intraductal papillary mucinous neoplasm (IPMN) and invasive mucinous carcinoma with preservation of the 1st jejunal branch of the superior mesenteric vein (SMV)

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  • Case Description

    • A 62 year old woman was referred for management of the incidental finding of a 1.5 cm solid and cystic lesion in the head of the pancreas.
    • Staging CT scans suggested interval growth to 2cm.
    • EUS and aspiration yielded a complex lesion with both cystic and solid components, not typical of a serous cystadenoma. FNA yielded 'atypical cells in a mucinous background'.
    • Working diagnosis was an Intraductal Papillary Mucinous Neoplasm (IPMN). Because of the apparent growth and solid components, resection was recommended. A pancreatico-duodenectomy (Whipple procedure) was planned.
  • Pathology slides

    • Images courtesy of Dr. Oyedele Adeyi, Toronto General Hospital. Click on the thumbnails below to view the pathology slides in full size. Best viewed in Mozilla Firefox, Google Chrome or Safari.

      Normal pancreas acini and duct (25x)

      IPMN: Papillary mucinous neoplasm distending and filling main pancreatic duct (25x)

      IPMN: Papillary mucinous neoplasm distending and filling main pancreatic duct (50x)

      IPMN: Papillary mucinous neoplasm distending and filling main pancreatic duct as well as invasive mucinous carcinoma (50x)

      Higher mag of invasive mucinous carcinoma (100x)