Intraductal papillary mucinous neoplasm (IPMN) is frequently found recently and is a precancerous lesion. Main duct-type should be resected since it can easily progress to invasive IPMN, whereas branch duct-type (BD) usually remains silent without malignant transformation. BD-IPMN should be resected if it has mural nodule, thick wall or septum, or solid component which are the obvious risk factors for malignancy. If the cyst size of BD-IPMN is more than 3 cm in diameter without obvious risk factors, it can be followed-up regularly or can be treated either with surgical resection or endoscopic ultrasonography (EUS)-guided ethanol lavage. Small BD-IPMN less than 3 cm in size without risk factors can be followed up with sonography, CT scan or EUS annually.
Adenocarcinoma, Mucinous/diagnosis/pathology/*therapy ; Carcinoma, Pancreatic Ductal/diagnosis/pathology/*therapy ; Carcinoma, Papillary/diagnosis/pathology/*therapy ; Diagnosis, Differential ; Ethanol/therapeutic use ; Humans ; Pancreatic Neoplasms/diagnosis/pathology/*therapy ; Risk Factors ; Tomography, X-Ray Computed

We observed a rare case of invasive mucinous adenocarcinoma (IMA) with a lepidic-predominant pattern accompanied by pulmonary tuberculosis. An 85-year-old man with repeated cough and sputum was admitted to Xinhua Hospital. T-SPOT test result was 212 pg/ml (reference value of negative is < 14 pg/ml), Mycobacterium tuberculosis culture was positive, and tuberculin skin test (PPD) was negative (skin induration < 5 mm). The patient was treated with several courses of antibiotics and anti-tuberculosis treatments. Repeated chest CT scans showed disease progression. Bronchoscopy yielded negative results. PET-CT scans showed negative results. A percutaneous lung biopsy revealed mucin-secreting cells lining the alveolar walls. IMA with a lepidic-predominant pattern was diagnosed after invasiveness was found after experimental treatments. Simultaneous occurrence of pulmonary tuberculosis and lung cancer are common; however, the present case of IMA having a lepidic-predominant pattern and coexisting with active tuberculosis has not been reported yet.
Adenocarcinoma, Mucinous ; diagnosis ; pathology ; Aged, 80 and over ; Antibiotics, Antitubercular ; therapeutic use ; Disease Progression ; Humans ; Lung Neoplasms ; diagnosis ; pathology ; Male ; Mycobacterium tuberculosis ; isolation & purification ; Positron Emission Tomography Computed Tomography ; Pulmonary Alveoli ; pathology ; Tuberculosis, Pulmonary ; diagnosis ; drug therapy

The patient was a 70-year-old male whose chief complaints were obstructive jaundice and weight loss. Abdominal imaging studies showed a 2.5 cm sized mass at the distal common bile duct, which was suggestive of bile duct cancer. Eccentric enhancing wall thickening in the transverse colon was also shown, suggesting concomitant colon cancer. A colonoscopy revealed a lumen-encircling ulcerofungating mass in the transverse colon, that was pathologically proven to be adenocarcinoma. The bile duct pathology was also adenocarcinoma. Pylorus-preserving pancreaticoduodenectomy and extended right hemicolectomy were performed under the diagnosis of double primary cancers. Postoperative histopathologic examination revealed moderately differentiated mucinous adenocarcinoma of transverse colon cancer, and mucinous adenocarcinoma of the distal common bile duct. Immunohistochemical staining studies showed that the bile duct cancer had metastasized from the colon cancer. The patient recovered uneventfully from surgery and will be undergoing chemotherapy for three months.
Adenocarcinoma ; Adenocarcinoma, Mucinous* ; Aged ; Bile Duct Neoplasms ; Bile Ducts ; Colon, Transverse* ; Colonic Neoplasms ; Colonoscopy ; Common Bile Duct Neoplasms ; Common Bile Duct* ; Diagnosis ; Drug Therapy ; Humans ; Jaundice, Obstructive* ; Male ; Mucins* ; Neoplasm Metastasis ; Pancreaticoduodenectomy ; Pathology ; Weight Loss

Adenocarcinoma, Mucinous ; pathology ; Adult ; Aged ; Chondrosarcoma ; pathology ; Chordoma ; pathology ; radiotherapy ; surgery ; Combined Modality Therapy ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; pathology ; radiotherapy ; surgery ; Neoplasm Recurrence, Local ; Paranasal Sinus Neoplasms ; pathology ; radiotherapy ; surgery ; Retrospective Studies ; Sphenoid Sinus