Ductal Carcinoma Arising in a Largely Unchanged Presumed Branch-duct IPMN After 10 Years of Surveillance

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Because the natural history of intraductal papillary mucinous neoplasm (IPMN) is still unknown, the progression to malignancy of an apparently benign IPMN and the development of new lesions is uncertain and unpredictable. Therefore, it is challenging to manage the increasing number of incidentally diagnosed pancreatic cysts.1 Current guidelines for surveillance, either pre- or post resection differ significantly and are debated, even proposing that surveillance should be discontinued after 5 years.2–4 In addition, separate pancreatic ductal adenocarcinomas (concomitant PDACs) are much more common in association with branch-duct IPMN (BD-IPMN),5 thereby making continued surveillance even more important. For that reason, we are presenting a case of malignant progression of a BD-IPMN after 10 years of quiescence.
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