A case of pancreatic serous cystadenoma with obstructive jaundice

Abstract

dence of an abdominal mass or ascites. Hematologic examinations revealed mild anemia. On blood chemical analysis, the alkaline phosphatase was 401 IU/L, g-glutamyl transferase (GTP) was 101 IU/L, amylase was 133 IU/L, blood urea nitrogen (BUN) was 40.5 mg/dL, and creatinine was 2.6 mg/dL. However, the total bilirubin was normal (0.6 mg/dL). As for tumor markers, the concentration of elastase I was mildly elevated (Table 1). Percutaneous transluminal gall-bladder drainage findingsA drainage tube was placed in the gall-bladder, and PTGBD revealed two radiolucent areas measuring 20 ¥ 20 mm each in the gall-bladder. The common bile duct was dilated (diameter, 15 mm), and compression and stenosis were present at the left side of the inferior portion of the common bile duct (Fig. 1). Endoscopic retrograde cholangiopancreatography findingsThe main pancreatic duct at the head of the pancreas showed irregular stenosis, extending to approximately 30 mm. The portion of the main pancreatic duct adjacent to the tail of the pancreas was sightly dilated. In addition, irregular compression and stenosis extended for approximately 26 mm at the left side of the common bile duct (Fig. 2). Brushing cytologic diagnosis of the pancreatic duct indicated a class II lesion. Abdominal angiography and cholangiographyImages obtained simultaneously by angiography and cholangiography revealed poor visualization of the intra-A 62-year-old man with precordial pain and fever consulted a local practitioner. Blood tests revealed jaundice. Acute cholecystitis was diagnosed on ultrasonographic examination, and percutaneous transluminal gall-bladder drainage was performed. The patient was referred to the Department of Surgery for operation. Imaging studies performed via a drain disclosed compression and stenosis of the lower portion of the common bile duct. A computed tomographic scan showed a multilocular nodule-like low-density area measuring 2.0 ¥ 2.0 cm in diameter at the head of the pancreas. Endoscopic retrograde cholangiopancreatography disclosed compression and stenosis of the main pancreatic duct at the head of the pancreas. Angiographic examination revealed encasement of the intrapancreatic branch of the posterior pancreatic arcade, located in the same area as the compression stenosis of the bile duct. The results of imaging studies suggested cancer of the head of the pancreas, and a pancreatoduodenectomy was performed. The resected specimen included a mass measuring 3.5 ¥ 2.7 ¥ 1.7 cm, which was located at the head of the pancreas. On examination of a cut section, the mass was found to consist of small multilocular cysts. The cysts invaded the intrapancreatic bile duct. The histopathological diagnosis was serous cystadenoma.

Left-sided portal hypertension caused by serous cystadenoma of the pancreas: Report of a case

“…11 Despite the benign nature of SCAs, huge tumors tend to compress or involve the surrounding structures, and sometimes obstruct the bile duct or involve the splenic vein. [12][13][14] Serous cystadenomas are generally resected to relieve symptoms, because they have grown to a large size, or if it is impossible to distinguish a serous cystic neoplasm from a mucinous lesion, which has greater malignant potential. Some authors have recommended resection for all cystic neoplasms of the pancreas, [15][16][17] whereas others insist on a more selective approach.…”

Serous cystadenoma of the pancreas associated with obstructive jaundice

“…2,[11][12][13][14][15][16][17] It should be kept in mind that serous cystadenoma of the pancreas can cause obstructive jaundice.…”

Successful Cystic Fenestration for a Macrocystic Serous Cystadenoma of the Pancreas Causing Obstructive Jaundice: Report of a Case

“…This inhibited bile flow, resulting in a buildup of concentrated bile debris or sludge in the stenotic part of the CBD, causing obstruction and consequently, obstructive jaundice. In the 12 documented cases of SCA with obstructive jaundice, [3][4][5][6][7][8][9][10][11][12] , including ours, the tumors were localized in the pancreatic head in all but one case, in which multiple cysts developed from the pancreatic head to the tail in a patient with von Hippel-Lindau's disease. 10 Serous cystadenoma was diagnosed preoperatively in only 3 of these 12 patients, whereas surgery was performed under a preoperative diagnosis of pancreatic carcinoma in the other 9.…”

“…Only a few cases of SCA of the pancreas with obstructive jaundice have been reported. [3][4][5][6][7][8][9][10][11][12] We report another case of macrocystic SCA of the pancreas causing obstructive jaundice, which we treated successfully by a cystic fenestration procedure. …”