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Intraductal Papillary Mucinous Neoplasm With Extensive Mural Osseous Metaplasia and Calcification

Runjan Chetty, Sangeetha N Kalimuthu, Korosh Khalili

Context This case highlights the unusual radiological findings of an intraductal papillary mucinous neoplasm presenting as a radiologically opacified lesion. This correlated histologically with extensive ossification and calcification of the wall of the cyst. Additionally, an accompanying intraductal tubular adenoma masqueraded as a mural nodule. Case report A seventy-year old man presented with vague epigastric pain and a CT-scan revealed a cystic pancreatic lesion with egg-shell opacification of the cyst wall. Pathological examination confirmed an intraductal papillary mucinous neoplasm of gastric type, low-grade dysplasia and an accompanying intraductal tubular adenoma in the distal pancreas. There was extensive osseous metaplasia and dystrophic calcification within the wall of the intraductal papillary mucinous neoplasm which accounted for the opacification noted radiologically. Based on these radiologic findings, the patient underwent a distal pancreatectomy and splenectomy. Conclusions extensive osseous metaplasia is exceedingly rare in intraductal papillary mucinous neoplasm, especially sufficient to result in a radiological opacification of the cyst and the presence of a concomitant intraductal tubular adenoma in a gastric type intraductal papillary mucinous neoplasm can masquerade radiologically as a mural nodule.