Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2022; 10(30): 11116-11121
Published online Oct 26, 2022. doi: 10.12998/wjcc.v10.i30.11116
Favorable response after radiation therapy for intraductal papillary mucinous neoplasms manifesting as acute recurrent pancreatitis: A case report
Ayaka Harigai, Kiyoshi Kume, Noriyoshi Takahashi, So Omata, Rei Umezawa, Keiichi Jingu, Atsushi Masamune
Ayaka Harigai, Noriyoshi Takahashi, So Omata, Rei Umezawa, Keiichi Jingu, Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
Kiyoshi Kume, Atsushi Masamune, Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
Author contributions: Harigai A, Takahashi N and Umezawa R reviewed the literature; Kume K and Umezawa R followed this case on outpatient department; Omata S and Umezawa R contributed to radiation therapy treatment planning; Harigai A, Kume K, Umezawa R, Jingu K and Masamune A contributed to manuscript drafting; and all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ayaka Harigai, MD, Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan. ayaka.harigai.e6@tohoku.ac.jp
Received: June 17, 2022
Peer-review started: June 17, 2022
First decision: August 1, 2022
Revised: August 17, 2022
Accepted: September 7, 2022
Article in press: September 7, 2022
Published online: October 26, 2022
Abstract
BACKGROUND

There has been an increasing number of elderly patients with intraductal papillary mucinous neoplasm (IPMN), who are surgically intolerant and require less invasive treatment options, which are limited. In the present study, we report a case of IPMN presenting with acute recurrent pancreatitis (ARP), in which radiation therapy effectively prevented further attacks of ARP and reduced tumor volume.

CASE SUMMARY

An 83-year-old man was referred to our hospital with an asymptomatic incidental pancreatic cyst. Endoscopic ultrasound imaging and magnetic resonance cholangiopancreatography revealed a multiloculated tumor in the head of the pancreas, with dilated pancreatic ducts and mural nodules. The patient was diagnosed with mixed-type IPMN, and five years later, he developed ARP. Several endoscopic pancreatic ductal balloon dilatations failed to prevent further ARP attacks. Surgery was considered clinically inappropriate because of his old age and comorbidities. He was referred to our department for radiation therapy targeted at those lesions causing intraductal hypertension and radiation was administered at a dose of 50 Gy. An magnetic resonance imaging scan taken ten weeks after treatment revealed a decrease in tumor size and improvement of pancreatic duct dilatation. Fourteen months later, he remains symptom-free from ARP.

CONCLUSION

This case highlights the important role of radiation therapy in mitigating the signs and symptoms of ARP in patients with inoperable IPMN.

Keywords: Intraductal papillary mucinous neoplasm, Acute recurrent pancreatitis, Pancreas, Radiation therapy, Case report

Core Tip: For intraductal papillary mucinous neoplasm (IPMN) patients with symptoms of acute recurrent pancreatitis (ARP), the only therapeutic option recommended by current guidelines is surgical intervention. However, a growing number of IPMN patients require minimally invasive treatment options because of old age, systemic conditions, or personal preference. Herein, we present a case of IPMN presenting with ARP, in which radiation therapy effectively prevented further attacks of ARP and reduced tumor volume. This case highlights the important role of radiation therapy in preventing further episodes of ARP in patients with IPMN who cannot undergo surgery.