ArticleClinical journal of gastroenterology2026
Undifferentiated carcinoma of the pancreas arising from intraductal papillary mucinous neoplasm: a case report.
Article in Clinical journal of gastroenterology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
A 75-year-old woman was referred for evaluation of a pancreatic cystic lesion. Serum tumor markers were normal. Contrast-enhanced computed tomography revealed a 35 mm cystic lesion in the pancreatic body with a 7 mm enhancing mural nodule. Magnetic resonance imaging showed slight T1 hyperintensity, T2 hypointensity, and diffusion restriction of the nodule. Contrast-enhanced endoscopic ultrasound demonstrated a broad-based mural nodule with a slightly irregular surface, heterogeneous internal echogenicity, and persistent enhancement from the early to late phases. The lesion was preoperatively diagnosed as branch-duct intraductal papillary mucinous neoplasm (IPMN) with high-risk stigmata, and middle pancreatectomy was performed. Histopathological examination showed that the cystic lesion was a gastric-type IPMN. The mural nodule consisted primarily of pleomorphic and spindle-shaped atypical cells in a hyalinized stroma with focal multinucleated giant cells. Transition from adenocarcinoma to undifferentiated carcinoma identified in the superficial layer led to the final diagnosis of spindle cell-type undifferentiated carcinoma arising from IPMN. This rare case suggests that even a small mural nodule in a pancreatic cystic lesion may exhibit histologically aggressive features. However, preoperative diagnosis of undifferentiated carcinoma of the pancreas remains challenging. Therefore, when a mural nodule is detected in a pancreatic cystic lesion, the treatment strategy, including the surgical procedure, should be carefully considered.
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