A case with pancreatic intraepithelial neoplasia of the pancreas and regional stenosis of the main pancreatic duct due to chronic pancreatitis

Abstract

A 79-year-old woman admitted for high fever and right upper quadrant pain was found in abdominal US to have wall thickening and several stones in the gallbladder, suggesting gallstone cholecystitis. Abdominal CT showed dilation of the main pancreatic duct but no lesion. ERP showed stenosis of the main pancreatic duct at the body of the pancreas and dilation at the tail. Cytology of the pancreatic juice was class III. Unable to rule out small pancreatic cancer, we conducted pancreatectomy of the body and tail and splenectomy and cholecystectomy. Pathological findings showed fibrous thickening of the main pancreatic duct at the stenotic portion and atrophy of the acinus around the duct, leading to a definitive diagnosis of main pancreatic stenosis due to localized chronic pancreatitis. We also found pancreatic intraepithelial neoplasia (PanIN) about 5cm toward the tail from the stenosis. © 2006 The Japanese Society of Gastroenterological Surgery.