Natural history of mucinous ductal ectasia of the pancreas: a case report and review of the literature.

Abstract

Mucinous ductal ectasia (MDE) remains a less known disease entity of the pancreas. In an attempt to further characterize its natural history, we report the case of a 68-yr-old man with MDE initially unrecognized in an abdominal CT obtained 5 yr before diagnosis and resection. Furthermore, we have reviewed available case reports in the English literature to clarify the differences between MDE and mucinous cystic neoplasm, two entities that have been frequently confused for one another. MDE is an uncommon disorder of the pancreas characterized by dilated primary and secondary ducts filled with thick mucus that appear as a mass or cyst by ultrasound or CT. ERCP demonstrates a patulous duodenal papilla with extruding mucin from the orifice. Histological changes within the ducts reveal hyperplasia, adenoma, or adenocarcinoma. The recognition of MDE is essential because early detection allows for curative surgical resection of these usually latent and indolent pancreatic neoplasms. Further characterization of MDE and additional longitudinal studies are necessary to elucidate its natural history and define its optimal management.