Case Report
Faisal Anwar, Mitchell GM III
Abstract
Intraductal Oncocyctic Papillary Neoplasm of the pancreas [IOPN] is the least common subset of intraductal papillary mucinous neoplasms [IPMN], and is an exceedingly rare cystic pancreatic tumor. In fact, IPMN makes up less than 5% of all pancreatic neoplasms, and IOPN makes up less than 5% of IPMN. Studies on this particular tumor are sparse to date, with only a few case reports and small series. It is distinct from other forms of pancreatic tumors in its regard to develop into invasive carcinoma, even after resection. The reason for such an aggressive recurrence after resection is the multifocal nature of IOPN; this elusive nature of IOPN gives practitioners a false sense of treatment success when a focus of IOPN is removed with clear margins, because a different focus may be close-by without being detected. Current treatment guidelines for benign IPMN recommend yearly surveillance with CT or MRCP for patients who undergo surgical resection without invasive characteristics. Additionally, even with negative surgical margins additional investigation with modalities such as pancreatoscopy is recommended in order to exclude non-contiguous spread of disease. This case illustrates the need for extreme vigilance both at the time of surgery and after in order to detect occult or recurrent tumor. There is a relative paucity of data on these neoplasms and it is possible more aggressive surgical approaches and surveillance are warranted.