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      A case of ruptured mucinous cystadenoma of the pancreas with recurrence-free survival for 8 years

      case-report

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          Abstract

          Background

          Pancreatic mucinous cystic neoplasm (MCM) presenting with rupture is extremely rare, and very few studies have followed up patients over the long term after ruptured mucinous cystadenoma (MCA). We report a case of ruptured MCA of the pancreas with recurrence-free survival for 8 years.

          Case presentation

          A 28-year-old Japanese woman was admitted to the emergency department of a local hospital after experiencing acute abdominal pain. Abdominal computed tomography revealed massive ascites and the presence of a cystic tumor measuring 60 mm in diameter in the pancreatic tail. Conservative therapy with antibiotics and abdominal drainage were performed to treat peritonitis that occurred secondary to the ruptured pancreatic cystic tumor, after which the patient’s symptoms improved. The patient was referred to our department for further examination and treatment. We diagnosed a ruptured MCN and performed laparoscopic spleen-preserving distal pancreatectomy. Histopathological findings revealed ovarian-type stroma, which tested positive for estrogen and progesterone receptors by immunohistochemistry. The histopathological diagnosis was MCA. The postoperative course was uneventful, and the patient remains alive without any evidence of recurrence at 8 years postoperatively.

          Conclusion

          A good prognosis is possible even in cases of ruptured MCA. Because of the risk of peritoneal dissemination after ruptured MCA, long-term follow-up is important.

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          Most cited references15

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          Cyst fluid analysis in the differential diagnosis of pancreatic cystic lesions: a pooled analysis.

          Laurens A van der Waaij, Hendrik van Dullemen, Robert Porte (2005)
          Pancreatic cystic tumors commonly include serous cystadenoma (SCA), mucinous cystadenoma (MCA), and mucinous cystadenocarcinoma (MCAC). A differential diagnosis with pseudocysts (PC) can be difficult. Radiologic criteria are not reliable. The objective of the study is to investigate the value of cyst fluid analysis in the differential diagnosis of benign (SCA, PC) vs. premalignant or malignant (MCA, MCAC) lesions. A search in PubMed was performed with the search terms cyst, pancrea, and fluid. Articles about cyst fluid analysis of pancreatic lesions that contained the individual data of at least 7 patients were included in the study. Data of all individual patients were combined and were plotted in scatter grams. Cutoff levels were determined. Twelve studies were included, which comprised data of 450 patients. Cysts with an amylase concentration 800 ng/mL strongly suggested MCA or MCAC (sensitivity 48%, specificity 98%). A carbohydrate-associated antigen (CA) 19-9 <37 U/mL strongly suggested PC or SCA (sensitivity 19%, specificity 98%). Cytologic examination revealed malignant cells in 48% of MCAC (n = 111). Most pancreatic cystic tumors should be resected without the need for cyst fluid analysis. However, in asymptomatic patients, in patients with an increased surgical risk, and, in patients in whom there is a diagnostic uncertainty about the presence of a PC, cyst fluid analysis helps to determine the optimal therapeutic strategy.
          Article 0 comments Cited 98 times – based on 0 reviews     Review now
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            Clinicopathological features and prognosis of mucinous cystic neoplasm with ovarian-type stroma: a multi-institutional study of the Japan pancreas society.

            Hideki Abe, Michio Shimizu, NORIYOSHI FUKUSHIMA … (2010)
            The aim of this study was to elucidate the clinicopathological features and prognosis of mucinous cystic neoplasms (MCNs). We performed a multi-institutional, retrospective study on a collected series of patients with MCN pathologically defined by ovarian-type stroma. Clinicopathological features and prognosis were investigated. Mucinous cystic neoplasm was confirmed in 156 cases, including 129 adenomas (82.7%) and 21 noninvasive (13.4%) and 6 invasive carcinomas (3.9%). Patients with MCN were exclusively women (98.1%) with the mean age of 48.1 years. All but 1 MCN were in the pancreatic body/tail region with a mean size of 65.3 mm. Communication between the cyst and the pancreatic duct was found in 18.1%. The 3-, 5-, and 10-year survival rates were 97.6%, 96.6%, and 96.6%, respectively. A significant difference in the survival rates was observed between adenomas and carcinomas and between minimally invasive carcinomas and invasive carcinomas. Cyst diameter and presence of mural nodule were predictive of malignant MCN. Mucinous cystic neoplasm is a rare but distinctive pancreatic cystic neoplasm with a favorable overall prognosis. All MCNs should be resected to prevent malignant changes but can be observed for an appropriate time when the lesion is small without the presence of mural nodules.
            Article 0 comments Cited 55 times – based on 0 reviews     Review now
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              Contrast-enhanced harmonic endoscopic ultrasonography for differential diagnosis of pancreatic cysts.

              Yoshifumi Takeyama, Ippei Matsumoto, Yasutaka Chiba … (2016)
              Comparison of fundamental B-mode endoscopic ultrasonography (FB-EUS) and contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) in the differential diagnosis of pancreatic cysts according to presence of mural nodules.
              Article 0 comments Cited 31 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Atsuro Fujinaga: a-yoshimura@oita-u.ac.jp
                Journal
                Journal ID (nlm-ta): Surg Case Rep
                Journal ID (iso-abbrev): Surg Case Rep
                Title: Surgical Case Reports
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Electronic): 2198-7793
                Publication date (Electronic): 16 March 2020
                Publication date PMC-release: 16 March 2020
                Publication date Collection: December 2020
                Volume: 6
                Electronic Location Identifier: 52
                Affiliations
                [1 ]GRID grid.412334.3, ISNI 0000 0001 0665 3553, Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, , Oita University, ; Idaigaoka 1-1, Hasama-machi, Oita, 879-5593 Japan
                [2 ]GRID grid.416794.9, ISNI 0000 0004 0377 3308, Department of Gastroenterology, , Oita Prefectural Hospital, ; Oita, Japan
                [3 ]GRID grid.412334.3, ISNI 0000 0001 0665 3553, Department of Gastroenterology, Faculty of Medicine, , Oita University, ; Oita, Japan
                Article
                Publisher ID: 816
                DOI: 10.1186/s40792-020-00816-x
                PMC ID: 7078394
                PubMed ID: 32185526
                SO-VID: 3fbc10c4-1b1e-4899-a695-ef0715a37584
                Copyright © © The Author(s) 2020
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                Date received : 24 January 2020
                Date accepted : 9 March 2020
                Categories
                Subject: Case Report
                Custom metadata
                issue-copyright-statement © The Author(s) 2020

                Keywords: mucinous cystadenoma of the pancreas,mca,rupture
                Data availability:
                Keywords: mucinous cystadenoma of the pancreas, mca, rupture

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