Answer of November 2006

Clinical History:

A 61-year-old gentleman with a history of recurrent episodes of epigastric pain for five years presented again with another severe attack. Ultrasonography and computed tomography of the upper abdomen were performed.

Diagnosis:

Intraductal papillary mucinous tumor (IPMT) of the pancreas

Discussion:

Ultrasonography showed a heterogeneous mass at the pancreatic head. The common bile duct and the pancreatic duct were dilated - the double duct sign. Contrast-enhanced computed tomography confirmed the presence of a complex cystic mass at the pancreatic head. The biliary tree and the pancreatic duct were dilated. The duodenal papilla was prominent and protruded into the duodenal lumen.

These findings are suggestive of Intraductal papillary mucinous tumor (IPMT) of the pancreas. The diagnosis can be confirmed by observing mucin oozing out of the duodenal papilla at ERCP, or by demonstrating communication between the cystic lesion and the pancreatic duct and Intraductal filling defect with various imaging modalities.