doiSerbia

The laparoscopic enucleation for branch duct type intraductal papillary mucinous neoplasms located at the body of pancreas: A case report

Stevanović Dejan (School of Medicine, Belgrade + Clinical Hospital Center Zemun, Belgrade)
Stojanović Dragoš (School of Medicine, Belgrade + Clinical Hospital Center Zemun, Belgrade)
Mitrović Nebojša (School of Medicine, Belgrade + Clinical Hospital Center Zemun, Belgrade)
Jašarović Damir (Clinical Hospital Center Zemun, Belgrade)
Milenković Sanja (Clinical Hospital Center Zemun, Belgrade)
Bokun-Vukašinović Zorana (Clinical Hospital Center Zemun, Belgrade)
Radovanović Dragan (School of Medicine, Belgrade + Clinical Hospital Center “Dr Dragiša Mišović - Dedinje”, Belgrade)

Introduction. Intraductal papillary mucinous neoplasms (IPMN) are among the most common cystic neoplasms of the pancreas, but they represent only 1-3% of all exocrine pancreas tumors. With the development of diagnostic possibilities the number of patients with IPMN is constantly increasing and represents approximately 20% of all surgically treated pancreatic tumors. The development of laparoscopic surgery has led to advances in the treatment of cystic tumors of the pancreas with the emergence of new surgical dilemma in the choice of surgical techniques in patients with IPMN. Case Outline. A 23-year-old patient was admitted to the hospital with non-specific symptoms of upper abdomen. Performed diagnostics indicated the existence of a tumor formation at the periphery of the pancreas, in the region of the proximal corpus, 8Ч5 cm in diameter. The cystic formation, wall thickness 3 mm, was filled with dense contents and injected into the tissue of the pancreas, but did not lead to an extension of the pancreatic duct. After adequate preoperative preparation the patient was operated on, when a laparoscopic enucleation of cystic tumor with coagulation and cutting off communication between the peripheral pancreatic duct and pancreatic tumors was performed by using ultrasound scissors. Histopathological analysis of the specimen indicated an IPMN of the branch duct type (BD-IPMN) with a low grade dysplasia. The line of resection was without cellular atypia. Immunohistochemical analysis showed positivity on tumor mucins (MUC-5 and MUC-2), which is typical for gastric type of BD-IPMN. Six months postoperatively the patient showed no signs of recurrence of the disease. Conclusion. Surgical treatment is the dominant choice for the treatment for IPMN. Although minimally invasive, laparoscopic enucleation of BD-IPMN is able to achieve an adequate level of radicality without the accompanying complications and with short postoperative recovery period.

Keywords: laparoscopic enucleation, pancreas, intraductalpapillary mucinous neoplasm