Intraductal Papillary Mucinous Neoplasia (IPMN) of the Pancreas

There are 3 types of IPMN
1-Main-duct type
2-Branch-duct type
3-Mixed type
Sometimes MR is not enough and we request endoscopic ultrasonography. At this patient who has mixed type of IPMN,by endosonography-guided fine-needle aspiration we diagnosed this patient has IPMN and high grade dysplasia.The patient has an old age and concomitant hearth and pulmonary disease. A result of this we made Celiac plexus neurolysis treatment, Because the patient is not suitable for pancreatectomy operation.
I want to start from the MR images.(1:07)We see the gallbladder duct and the pancreas duct.There was a 2,5 cm cystic lesion above the pancreas duct. By reconstruction we removed the main gallbladder.This is a main-duct type of IPMN.and we decided to make endosonograhy guided fine needle aspiration here.
(2:05) here we make fine needle aspiration but we should make very carefully.This patient has icterus because of that we placed metallic stent.we are not perforating the stent. By entering with needle we take a sample from the cyst fluids.and we sent laboratory.and we we made Celiac plexus neurolysis treatment because of not suitable for the operation. From the reults,the cyst fluid amylase is high.Sito patalogy report, sitomorfologic symptomps are biliary and gastric type,ıt makes you think main-duct and branch-duct type IPMN. Cytomorphological findings shows gastric and biliary type mixed type IPMN.
CEA 2557ng/ml, Amilaz 2010 U/l and Ca 19-9 were high.