PMC7548937_01
Axial fat-suppressed T2-weighted MRI sequences. A: Presence of a BD-IPMN located in the head of the pancreas measuring 22 x 17 mm (white arrow) B: MD-IPMN measuring 10.4 mm extending from the head to the neck of the gland (white arrow). C: Normal main pancreatic duct in the pancreatic body and tail (yellow arrows) and large left renal cyst classified as Bosniak 1 (red arrow).gr1
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Magnetic resonance cholangiopancreatography (MRCP) showed that the main pancreatic duct had cephalic ectasia, with a maximum dilation of 10.4 mm, and revealed the presence of a cyst, measuring 22 x 17 mm, located in the head of the pancreas that communicated with the main pancreatic duct (Fig. 1, Fig. 2).
A: Transverse margin of the frozen sample of the main pancreatic duct, at the height of the gland neck, without evidence of neoplastic involvement (HE 100 x). B: MD-IPMN with high-grade dysplasia; it is possible to identify cell pleomorphism with intense architectural disarray and budding into the main pancreatic duct lumen, without invasion or rupture of the lamina propria (HE 200 x).gr3
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The examination showed that the main pancreatic duct was free from disease involvement (Fig. 3A). The histopathological study of the surgical specimen showed the presence of MD-IPMN located in the head of the pancreas with areas of high-grade dysplasia (Fig. 3B) and several other BD-IPMNs with low-grade dysplasia, the largest being in pancreatic head and measuring up to 22 mm.
A: Axial fat-suppressed T2-weighted MRI sequence four years after surgery: main pancreatic duct with a normal caliber and without progression of the disease or new pancreatic cystic lesions (yellow arrows). B: Axial fat-suppressed T1-weighted MRI sequence: pancreatic remnant (white arrows).gr4
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The BD-IPMNs located in the nonresected body and tail remain subcentimeter in size without any increases in size (Fig. 4).