PMC5686876_01
Patient with intraductal papillary mucinous neoplasm (IPMN) and intra-abdominal bleeding: (a) a 74-year-old woman was followed for IPMN in the pancreatic head (arrowheads). The size did not change for 5 years. (b) Contrast-enhanced computed tomography showed IPMN rupture and intra-abdominal bleeding (arrowheads).
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She had been followed every 6 months for an IPMN in the pancreatic head (Figure 1(a)), with no mural nodules and no changes in the size of the tumor over the past 5 years on abdominal ultrasonography and computed tomography (CT). The main pancreatic duct was not dilated on CT (Figure 1(b)).
Digital subtraction angiography images: (a) arteriography of a gastroduodenal artery (GDA) branch (superior pancreaticoduodenal artery) demonstrated tumor bleeding (arrowhead) and (b) a microcatheter was advanced near the bleeding point of the posterior superior pancreaticoduodenal artery (arrowhead). Embolization was performed using a gelatin sponge.
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TAE was performed using a gelatin sponge (Figure 2).
Macroscopic and pathological findings: (a) macroscopic observations revealed that the resected cystic mass comprised a dark red, partially organized hematoma; (b) pathological examination revealed a growing papillary tumor characterized by low-grade dysplasia in the intrapancreatic duct; and (c) focal infiltration of hemosiderin-laden macrophages was observed in the pancreatic parenchyma.
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During the operation, a ruptured cystic mass with hematoma was seen in the pancreatic head, and the tumor was completely removed with tumor-free margins (Figure 3(a)). Upon microscopic examination, the resected specimen showed a growing papillary tumor characterized by low-grade dysplastic cells in the intrapancreatic duct (Figure 3(b)), with a hematoma due to fresh and old bleeding. Focal infiltration of hemosiderin-laden macrophages was observed in the pancreatic parenchyma (Figure 3(c)).