Spectrum of mucus-secreting pancreatic neoplasia.

Mucus-secreting pancreatic lesions, most commonly described by the Japanese, are often malignant (as in cystic or mucin-producing adenocarcinomas), but can be benign (hyperplastic or adenomatous cytology). We report a case of total pancreatic ductal enlargement without a localized lesion in which abdominal pain was relieved by endoscopic sphincterotomy and partial septotomy in which cytology remains benign. In the absence of pancreatic cyst, mass, or localized ductal abnormality, total pancreatectomy is the only treatment that can completely remove the risk of malignant degeneration of apparently benign, mucus-secreting pancreatic ductal enlargement. Disability after total pancreatectomy is severe, but the risk of metastasis from mucinous ductal ectasia is low without pancreatic cyst or mass. Therefore, regular observation of mucus-secreting ductal enlargement with computerized tomography and pancreatography are appropriate, especially in older patients. Endoscopic sphincterotomy may relieve symptoms and allow access for ampullary biopsy and brushings.