PMC6319686_01
(A) Endoscopic ultrasound demonstrating a papillary growth in a dilated pancreatic duct in the head of the pancreas of the first patient. (B) Endoscopic image of the first patient's major duodenal papilla with mucin extrusion, suggestive of IPMN. (C) Magnetic resonance cholangiopancreatography demonstrating the second patient's diffuse pancreatic dilatation. IPMN, intraductal papillary mucinous neoplasm.
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In addition, free mucin was seen exiting the main papilla, and there was a papillary growth noted in the pancreatic duct in the head of the pancreas, all of which was consistent with a main duct IPMN (Fig. 1).
(A) Low-power pathologic slide from the second patient demonstrating the key features of colloid carcinoma, with extensive mucin pools and scattered neoplastic cells within them in the bottom of the photograph. Associated IPMN can also be seen as the ductal cells with papillary projections (arrow). (B) Higher power image depicting additional detail.
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Magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography demonstrated diffuse dilation of the pancreatic duct up to 7.5 mm with an associated cystic mass in the head of the pancreas, suggestive of main duct IPMN (Fig. 2). Her final pathology demonstrated a 1.1 cm well-differentiated mucinous colloid carcinoma arising in a background of IPMN (intestinal type) with foci of high-grade dysplasia and intermediate grade dysplasia throughout the remaining pancreatic duct (Fig. 2).