Mustafa ÖZSOY, Ahmet BAL, Emre KAÇAR, Taner ÖZKEÇECİ, Yüksek ARIKAN, Yücel GÖNÜL, Bahadır CELEP

PANKREASIN INTRADUKTAL PAPİLLER MUSİNÖZ NEOPLAZİLERİ: OLGULAR EŞLİĞİNDE LİTERATÜRE GENEL BAKIŞ

İlk kez Morohoshi tarafından tanımlanan intraduktal papiller müsinöz neoplasmlar pankreasın ne- oplastik kistik kitleleri içerisinde gerek klinik gerekse tanı koymadaki zorluklar nedeniyle ayrı öne- me sahiptir. 39 yaşında kadın hasta, karın ağrısı ve sarılık şikâyeti nedeniyle başvurdu. Karın tomog- rafisinde pankreas baş lokalizasyonda 4 cm çapında tümoral kitle saptandı. Endoskopik retrograd kolanjiopankreatikografide yoğun musin sekresyonu görüldü. Cerrahi piyesin histopatolojik ince- lemesi sonucunda malign İPMN tanısı konularak adjuvan kemoterapi uygulandı. 66 yaşında erkek hasta, sarılık nedeniyle tetkik edildi. Biyokimyasal verilerinin incelenmesinde total bilirubin: 5 mg/ dl, aspartat aminotransferaz enzimi: 350 U/L saptandı. Pozitron emisyon tomografisinde pankreas başı lokalizasyonunda hipermetabolik kitlenin dışında ek odağa rastlanmadı. Cerrahi spesmenin histopatolojik incelemesinde epitelde yüksek dereceli displazi saptandı. İPMN düşünülen olgular premalign kabul edilip vakit kaybetmeden cerrahi rezeksiyon uygulanmalıdır. İPMNlerde nadiren nüks ve metastaz bildirilse de rezeksiyon sonrası prognozları oldukça iyidir.

Intraductal Papillary Mucinous Neoplasms of Pancreas: Overview of the Literature with Cases

Intraductal papillary mucinous neoplasm defined by Morohoshi for the first time, have great importance in neoplastic cystic masses of the pancreas due to the difficulties in diagnosis and clinical trials. 39 years old female patient was admitted to the emergency department with complaints of abdominal pain and jaundice. The tumoral mass approximately 4 cm diameter in pancreatic head localization was found in abdominal tomography. Mucin secretion was detected in endoscopic retrograde cholangiopancreatography. In surgical piece histopathological examination, malignant IPMN was diagnosed and patient underwent adjuvant chemotherapy. A 66 years old, male patient was admitted with jaundice. There were no features on physical examination and also total bilirubin: 5 mg/dl, aspartate aminotransferase enzyme: 350 U/L were determineted respectively. Only a hypermetabolic focus group was observed in the head of pancreas in positron emission tomography. In histopathological examination of the surgical piece, high grade dysplasia was observed in epithelia. Surgical resection should be accepted for IPMN without delay. Although the recurrence and metastasis in IPMN have been indicated, the prognosis of after resection is pretty good.

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