C P Fischer1, I Pope, O J Garden. 1. Department of Surgical and Clinical Sciences (Surgery), University of Edinburgh, Royal Infirmary of Edinburgh, UK.
Abstract
BACKGROUND: The optimal therapy for mucinous neoplasms of the pancreas is surgical resection because these tumours are either premalignant (cystadenoma) or malignant. CASE OUTLINE: A 44-year-old previously fit woman presented with sudden onset of epigastric pain. Clinical and laboratory findings were consistent with acute pancreatitis. Abdominal ultrasound scan demonstrated a mature 6-cm cyst in the tail of pancreas and no findings suggestive of cholelithiasis. These findings were confirmed by a CT scan, which also demonstrated splenic infarction and evidence of recent haemorrhage into the cyst. The patient's abdominal pain persisted after amylase levels returned to normal. RESULTS: Splenic infarction, a mature cyst in the tail of the pancreas, and peripancreatic inflammation consistent with recent pancreatitis were found at laparotomy. Enbloc distal pancreatectomy and splenectomy were performed. Histological examination of the cyst wall demonstrated a focus of mucinous cystadenoma. DISCUSSION: This case demonstrates that acute pancreatitis may be the first presentation of a cystic neoplasm.
BACKGROUND: The optimal therapy for mucinous neoplasms of the pancreas is surgical resection because these tumours are either premalignant (cystadenoma) or malignant. CASE OUTLINE: A 44-year-old previously fit woman presented with sudden onset of epigastric pain. Clinical and laboratory findings were consistent with acute pancreatitis. Abdominal ultrasound scan demonstrated a mature 6-cm cyst in the tail of pancreas and no findings suggestive of cholelithiasis. These findings were confirmed by a CT scan, which also demonstrated splenic infarction and evidence of recent haemorrhage into the cyst. The patient's abdominal pain persisted after amylase levels returned to normal. RESULTS:Splenic infarction, a mature cyst in the tail of the pancreas, and peripancreatic inflammation consistent with recent pancreatitis were found at laparotomy. Enbloc distal pancreatectomy and splenectomy were performed. Histological examination of the cyst wall demonstrated a focus of mucinous cystadenoma. DISCUSSION: This case demonstrates that acute pancreatitis may be the first presentation of a cystic neoplasm.