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Case Reports
. 2022 Oct 26;10(30):11116-11121.
doi: 10.12998/wjcc.v10.i30.11116.

Favorable response after radiation therapy for intraductal papillary mucinous neoplasms manifesting as acute recurrent pancreatitis: A case report

Ayaka Harigai  1 , Kiyoshi Kume  2 , Noriyoshi Takahashi  3 , So Omata  3 , Rei Umezawa  3 , Keiichi Jingu  3 , Atsushi Masamune  2
Affiliations
Case Reports

Favorable response after radiation therapy for intraductal papillary mucinous neoplasms manifesting as acute recurrent pancreatitis: A case report

Ayaka Harigai et al. World J Clin Cases. .

Abstract

Background: There has been an increasing number of elderly patients with intraductal papillary mucinous neoplasm (IPMN), who are surgically intolerant and require less invasive treatment options, which are limited. In the present study, we report a case of IPMN presenting with acute recurrent pancreatitis (ARP), in which radiation therapy effectively prevented further attacks of ARP and reduced tumor volume.

Case summary: An 83-year-old man was referred to our hospital with an asymptomatic incidental pancreatic cyst. Endoscopic ultrasound imaging and magnetic resonance cholangiopancreatography revealed a multiloculated tumor in the head of the pancreas, with dilated pancreatic ducts and mural nodules. The patient was diagnosed with mixed-type IPMN, and five years later, he developed ARP. Several endoscopic pancreatic ductal balloon dilatations failed to prevent further ARP attacks. Surgery was considered clinically inappropriate because of his old age and comorbidities. He was referred to our department for radiation therapy targeted at those lesions causing intraductal hypertension and radiation was administered at a dose of 50 Gy. An magnetic resonance imaging scan taken ten weeks after treatment revealed a decrease in tumor size and improvement of pancreatic duct dilatation. Fourteen months later, he remains symptom-free from ARP.

Conclusion: This case highlights the important role of radiation therapy in mitigating the signs and symptoms of ARP in patients with inoperable IPMN.

Keywords: Acute recurrent pancreatitis; Case report; Intraductal papillary mucinous neoplasm; Pancreas; Radiation therapy.

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Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Figures

Figure 1
Figure 1
Pancreas magnetic resonance imaging scan at referral 5 years ago. A: Axial T2-weighted imaging (T2WI) image shows a multilobular tumor in the head of pancreas (arrow head); B: T2WI image shows pancreatic duct dilatation (arrow head); C: Magnetic resonance cholangiopancreatography shows a multilobular tumor (arrow head) and pancreatic duct dilatation (arrow).
Figure 2
Figure 2
Pancreatic magnetic resonance imaging scans of pre- and post-radiation therapy. A-C: T2-weighted imaging single scans and magnetic resonance cholangiopancreatography (MRCP) taken one month before radiation therapy; D-F: Magnetic resonance imaging scans and MRCP taken three months after radiation therapy. T2WI: T2-weighted imaging; MRCP: Magnetic resonance cholangiopancreatography.
Figure 3
Figure 3
Computed tomography image with dose distribution of radiation therapy. A: An axial image; B: A coronal image. White, red, inner-orange, outer-orange and yellow lines show 52.5 Gy, 50 Gy, 47.5 Gy, 45 Gy and 42.5 Gy, respectively.
See this image and copyright information in PMC

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