Vyacheslav Egorov, Irene Esposito, Natalya Ratnikova, Natalia Starostina, Roman Petrov
A thirty six-year old woman was treated for acute massive upper gastrointestinal bleeding in a local hospital. A day after the bleeding she was referred to the 5th City Hospital of Moscow. Due to severe anemia and jaundice the patient was admitted to the intensive care unit and after computed tomography and endoscopy a multi-nodular tumor of the pancreatic head, body and tail with invasion of the duodenum was identified as a source of bleeding. Total duodenopancreatectomy with lymphadenectomy and splenectomy was performed few days after admission. Postoperative course was uneventful. Pathomorphological examination revealed an invasive tubulo-papillary carcinoma of the pancreatic head on the background of an intraductal tubulo-papillary neoplasm, which involved the whole pancreas. This case is the first description of intraductal tubulo-papillary neoplasm with total pancreas involvement associated with jaundice and massive gastrointestinal bleeding. This option of intraductal tubulo-papillary neoplasm natural history has to be taken into consideration in diagnostics and treatment of pancreatic tumors.
