Pancreatic Mucinous Cystadenocarcinoma Presenting with Splenic Infarction in a Young Female
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CASE REPORT
Pancreatic Mucinous Cystadenocarcinoma Presenting with Splenic Infarction in a Young Female Shoaib Ahmad & Sian Chisholm & John Maple
Published online: 7 January 2012 # Springer Science+Business Media, LLC 2012
Introduction Cystic neoplasms of the pancreas account for a substantial proportion of pancreatic cystic lesions and about 1% of pancreatic malignancies [1]. Mucinous cystadenoma is a pancreatic neoplasm that is almost exclusively seen in females, with a mean age of presentation of 45 years [2]. Mucinous cystadenoma mostly (>90%) arises in the body and tail of pancreas and maybe unilocular or multilocular. Mucinous cystadenoma carries a risk for malignant transformation, and the incidence of carcinoma in situ (CIS) in resected mucinous cystic neoplasms (MCNs) is 25–50%. Pancreatic pseudocysts constitute a majority of cystic lesions of the pancreas, and it is important to distinguish pseudocysts from cystic neoplasms of the pancreas because of difference in management of these two clinical entities. Pancreatic cystic lesions are usually identified in patients who are asymptomatic or have nonspecific symptoms such as vague abdominal pain and weight loss, on abdominal imaging with computed tomography (CT) scan or magnetic resonance imaging (MRI) [3]. Endoscopic ultrasound (EUS) is useful for providing detailed imaging of cystic pancreatic lesions, because the endoscope can be placed close to the cystic lesion and guide fine-needle aspiration (FNA) of cystic fluid [4]. We report an unusual case of pancreatic mucinous cystadenocarcinoma presenting in a 39-year-old female with a remote history of acute pancreatitis, who presented with left upper quadrant abdominal pain. CT scan of abdomen and pelvis showed a unilocular 5.2×4.8 cm cystic lesion in the tail of pancreas suspected to be a pseudocyst, and an irregular area of low density within the posterior–inferior S. Ahmad (*) : S. Chisholm : J. Maple OUHSC, Oklahoma City, OK, USA e-mail: [email protected]
aspect of spleen consistent with splenic infarct. On endoscopic ultrasound, a large cystic lesion was seen and FNA was performed. Distal pancreatectomy, splenectomy and partial gastrectomy were performed. Histologic study confirmed the diagnosis of pancreatic mucinous cystadenocarcinoma. The patient had no postsurgical complications and was discharged with outpatient oncology follow up. The differentiation between pancreatic pseudocyst and cystic neoplasms of the pancreas is important because the treatment of these entities is quite different.
Case Report A 39-year-old Caucasian female presented with complaints of left upper quadrant abdominal pain for 2 months, with increasing intensity over the last 2 weeks prior to admission. The pain was characterized as dull initially, later becoming sharp, constant, nonradiating, with no aggravating or relieving factors. Abdominal pain was associated with nausea, vomiting, early satiety and a sensation of fullness in her abdomen. Her medical history was significant for acute pancreatitis in 2007 with forma
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