Answer
From question on page 1703
Extensive pancreatectomy of the residual pancreas was carried out and histological examination showed intraductal papillary mucinous adenoma with moderate atypia. Pathological findings were similar to those of the previously resected specimen. Atypical cells were not identified at the previous surgical margin.
First described in 1982,1 intraductal papillary mucinous neoplasm has recently been established as a distinct entity.2 The clinical manifestation of this disease shows slow growth, rarely infiltrating the surrounding parenchyma, and a relatively better prognosis.3 However, synchronous and metachronous development based on the coexisting potential for developing malignant epithelium along the whole pancreatic duct has been recognised as one of the clinical issues to be noted.4,5,6,7 A sequence from atypical hyperplasia to adenoma to carcinoma is often observed. The biological behaviour of this entity creates debates on how and what kind of strategies should be selected for appropriate treatment. An international consensus guideline has recently been proposed for management of intraductal papillary mucinous neoplasms.8 A close follow‐up is needed after surgical treatment under the present situation. Genetic approaches are awaited to help predict the risk of metachronous tumour development in such difficult cases.
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