Development of Malignancy in Operative Bed Shortly After Resection of Intraductal Papillary Mucinous Neoplasm With High-Grade Dysplasia

Branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) are macroscopically visible precursor lesions of pancreatic ductal adenocarcinoma (PDAC). Multiple societal guidelines recommend surveillance with the goal of detecting high-grade dysplasia (HGD) and early-stage PDAC to improve survival. Timely resection of HGD before development of invasive carcinoma is thought to be curative. Although studies have reported recurrent IPMNs and/or PDACs in the remnant pancreas, to our knowledge no studies have reported PDAC in the surgical bed in the first 2 years after IPMN resection. Development of carcinoma in the surgical bed can be subtle and challenging for radiologists to distinguish from postoperative changes. However, early detection of malignancy can impact clinical management. This case illustrates local development of PDAC 1 year after resection of BD-IPMN with HGD in the absence of invasive carcinoma.