ABSTRACT. We report a case of a mucinous cystadenoma of the pancreas communicating with the main pancreatic duct. To our knowledge, this is the first case in which a communication between the mucinous cystadenoma and the main pancreatic duct could be demonstrated by MRI. We report a case of a mucinous cystadenoma communicating with the main pancreatic duct. To our knowledge, this is the first case in which a communication has been demonstrated on MRI.
Case presentationA 56-year-old woman with no significant medical history presented for evaluation of left lumbar pain. She denied alcohol consumption, trauma and previous pancreatitis. She also denied significant nausea, vomiting, dyspepsia, diarrhoea and weight loss. Initial laboratory analyses, which included a complete blood cell count, liver function tests and measurement of electrolyte and pancreatic enzyme levels, were normal. Physical examination did not reveal a palpable mass.Abdominal sonography demonstrated a large cystic mass in the left pancreas, with back wall enhancement. This mass was multilocular with bright foci within the septation. Sonography showed a markedly dilated main pancreatic duct (Figure 1).T 2 weighted MRI revealed an overall high signal intensity of the lesion and low signal intensity of the internal septations. Two-dimensional (2D) and threedimensional (3D) MR cholangiopancreatographies showed a communication between the cystic lesion and the dilated main pancreatic duct (Figure 2). The diameter of the main pancreatic duct gradually decreased up to the papilla. There was no dilatation of the side branch system in the head of the pancreas, or of the common bile duct. A 3D T 1 weighted gradient echo sequence, performed after gadolinium contrast injection, showed a low-intensity mass with contrast enhancement of the capsule and the internal septae.From the MRI findings, and largely because of the communication with the main pancreatic duct, a diagnosis of IPMN was proposed.The lesion was removed by means of laparoscopic partial distal pancreatectomy with spleen and splenic vessel conservation. The gross specimen showed an approximately 8 6 7 cm cystic tumour. Drainage of the multiple cysts produced fluid. The walls were composed of homogeneous greyish white and glistening tan tissue. No papillary or solid areas were present. The communication between the main pancreatic duct and the cystic tumour was confirmed.Histological examination of the cyst wall showed mucin-producing columnar epithelium overlying ovarian-type dense stroma and fibrous tissue (Figure 3). Extensive sampling revealed no area of malignancy. The histopathological diagnosis was MCN of the pancreas.
DiscussionThe term ''cystadenoma'' was used to describe cystic neoplasms until 1978. At that time, the tumours were first classified and divided into serous cystic neoplasms and MCNs by Compagno and Oertel [2]. More recently,
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