Figure 1: Recurrent main-duct IPMN following partial pancreatectomy. This series of images illustrate the clinical evolution of a main-duct Intraductal Papillary Mucinous Neoplasm (IPMN) in a 66-year-old female who presented with multiple episodes of pancreatitis. (a.). Focal dilation of the pancreatic duct in the head of the pancreas (thin arrowhead) with normal caliber duct in the body and tail. (b.). Pancreatoscopy: fish egg lesion (thin arrow) consistent with focal main-duct IPMN. The patient underwent an uncomplicated pancreaticoduodenectomy with negative resection margins (R0). Final pathology revealed a three cm main-duct IPMN with low-grade dysplasia in the pancreatic head. (c & d.). Routine follow-up computed tomography revealed progressively worsening dilation of the main pancreatic duct (from four mm up to 25 mm) in the body (block arrowhead in the coronal plane) and tail (block arrow in the axial plane). Three years after her original surgery she underwent an uncomplicated completion pancreatectomy. Final pathology analysis revealed extensive high-grade dysplasia without any evidence of invasive cancer nor metastatic lymph nodes (0/36). The patient is currently disease free at approximately 50 months following her initial partial pancreatectomy.