Mucinous cystadenocarcinoma of the pancreas diagnosed in postpartum.

BACKGROUND: Cystic tumors of the pancreas are uncommon. They account for 10-15% of all pancreatic cystic masses and only 1% of pancreatic malignancies. Mucinous cystadenocarcinoma is the most frequent pancreatic cystadenocarcinoma and it is mainly seen in women, suggesting a sex hormone influence. Its presentation during pregnancy is infrequent and entails difficult diagnostic and therapeutic decisions. We report the case of a 31-year-old woman who presented a pancreatic cystadenocarcinoma 2 months after delivery.
MATERIALS AND METHODS: A 31-year-old woman was referred to our service because of abdominal pain and mass. She had given birth to her first child 2 months previous. Abdominal ultrasound demonstrated a poorly circumscribed cystic mass in the left upper abdominal quadrant, and the computed tomography scan showed a multilocular cystic lesion located in the body of pancreas. There was no seric alteration of specific pancreatic enzymes or tumor markers.
RESULTS: Laparoscopic examination showed a large cystic tumor (12 x 11 x 5.5 cm) in the pancreas involving the body and the tail. It extended to the spleen and was highly vascularized, precluding a minimal invasive resection. An open body-tail pancreatectomy and splenectomy was performed. The resection margins were free of tumor, and the histological study showed a mucinous pancreatic cystadenocarcinoma with mucin-producing columnar epithelium and associated papillae patterns, reminiscent of ovarian stroma. Immunohistochemical studies were negative for hormonal receptors. The patient had no post-surgical complications and was discharged home in 4 days.
CONCLUSIONS: Cystic tumors of the pancreas are infrequent, and cancer of the pancreas during pregnancy is extremely rare. Insidious symptoms and bodily changes due to pregnancy may mask diagnosis. Aggressive surgery is currently the only chance of cure.