ISSN: 2574-8009
Authors: Jagdish RK , Kapoor H and Belagodu MN
Intraductal papillary mucinous neoplasms (IPMNs) are premalignant pancreatic cystic lesions often detected incidentally during imaging studies. Differentiating IPMNs from other pancreatic pathologies, such as chronic pancreatitis or malignancy, poses a diagnostic challenge due to overlapping clinical and radiological features. This case report presents a rare instance of IPMN associated with portal vein plaquing and biliary obstruction in a 77-year-old male, whose medical history included chronic liver disease and diabetes mellitus. Initial imaging via contrast-enhanced computed tomography (CECT) and MRI revealed a cystic lesion in the pancreatic head, main pancreatic duct dilation, biliary obstruction, and portal vein abnormalities. Tumor markers were normal, and endoscopic ultrasound-guided fine-needle aspiration cytology (EUS-FNAC) confirmed the mucinous nature of the lesion without evidence of malignancy. Histopathological examination further validated the diagnosis of IPMN without high-risk stigmata. Notably, the patient’s amoebic serology tested positive, introducing an additional diagnostic dimension. The coexistence of portal vein plaquing, likely related to chronic liver disease, and IPMN presents a unique diagnostic and management challenge. A multidisciplinary approach ensured accurate diagnosis and effective management, which included conservative treatment for the IPMN and alleviation of biliary obstruction. This case underscores the importance of integrating advanced imaging, cytology, and clinical expertise in the evaluation of complex pancreatic lesions while emphasizing the need for ongoing surveillance in low-risk IPMN cases.
Keywords: Intraductal Papillary Mucinous Neoplasm; Portal Vein Plaquing; Biliary Obstruction; Pancreatic Malignancy; Endoscopic Ultrasound
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