Cystadenocarcinoma of the pancreas presenting in pregnancy

Abstract

A 33-year-old woman presented with sudden, severe, pain in her left iliac fossa, associated with left shoulder tip pain and a feeling of faintness. She had noticed upper lumbar backache over the previous month, and thought she was 7 weeks pregnant. Examination revealed her to be pale, normotensive with tachycardia, and with lower abdominal tenderness worse on the left side. There was left forniceal tenderness and marked cervical tenderness on vaginal examination. With a diagnosis of ruptured ectopic gestation she was transferred to the operating theatre.Through a lower transverse abdominal incision the pelvis was noted tocontain 200 ml of milky fluid with uterine enlargement consistent with 7 weeks gestation. A large firm mass was palpated behind the stomach. A left subcostal incision was made and a smooth, 10 cm diameter cystic swelling was seen in the body and tail of the pancreas. There were no signs of invasion, inflammation, fat necrosis or overt rupture of the tumour. The tumour was opened and found to contain the same fluid as that found in the pelvis. The mass was thought to be a necrotic pancreatic cyst. Biopsies were taken of the wall and a cystgastrostomy was fashioned. Biopsy histology revealed a moderately differentiated, papillary, mucin secreting adenocarcinoma.Her pregnancy was confirmed and the patient requested termination which was performed just before distal pancreatectomy, lOdays after the original surgery. Excision of the tumour included a 2 cm cuff of normal pancreas, a cuff of stomach at the cystgastrostomy site, and the spleen. Histology showed a cystadenocarcinoma of the pancreas with separate areas consistent with benign cystadenoma. Her postoperative recovery was uneventful. DiscussionCystadenocarcinoma is biologically different from ductal adenocarcinoma of the exocrine pancreas. I t occurs a t a younger age (4&50 years) with a 3:l female preponderance'. The tumours originate from the exocrine glandular elements and malignant change may occur in benign cystadenomas'.'. There is frequently coexistence of malignant and benign elements allowing histological sampling error, thus prompting recommendation for total removal for histological examinationlS2. A 5-year survival rate of 65 per cent has been reported following complete excision of the carcinoma2. I n our patient the tumour was asymptomatic until the spontaneous leak during pregnancy. Leak from this malignancy has not been reported and pregnancy may have played some role. There have been recent reports of hormonal influence on experimental ductal carcinoma of the pancreas, with androgens stimulating and antiandrogens inhibiting tumour growth3. A report from Norway supports this premise and has shown increased survival in a small group of patients, with disseminated ductal carcinoma treated with tamoxifen4. Given these d a t a and the 3:l female preponderance in tumour incidence, it could be postulated that these tumours may be hormonally dependent. The effect of the pregnancy in our patient may have increased tumour activity and p...

Large mucinous cystic neoplasm of the pancreas associated with pregnancy

“…To our knowledge, eight cases of pancreatic MCN associated with pregnancy have been reported since the first report in 1968 by Smithers et al [7] . Four cases were histologically diagnosed as benign mucinous cystadenoma [3][4][5][6] , while the other four were diagnosed as mucinous cystadenocarcinoma [7][8][9][10] .…”

“…Four cases were histologically diagnosed as benign mucinous cystadenoma [3][4][5][6] , while the other four were diagnosed as mucinous cystadenocarcinoma [7][8][9][10] . Our case might be the first case of pancreatic MCN with moderate dysplasia (also referred to as "borderline tumor"), in association with pregnancy.…”

“…Pancreatic MCNs occur almost exclusively in females, and are potentially sex hormonesensitive, according to the studies reported to date [2] . However, MCNs encountered in pregnancy are rare; only eight such cases have been reported in the English literature [3][4][5][6][7][8][9][10] . In this report, we describe a 30-year-old woman with a large pancreatic MCN that grew rapidly during the early stage of pregnancy.…”

Non-functioning, malignant pancreatic neuroendocrine tumour (PNET): a rare entity during pregnancy

“…Several authors report on cases of extremely rapid tumour growths during pregnancy, such as mucinous cystic tumours of the pancreas [17][18][19]. Ganepola et al [20] presented an immunohistochemical study showing the influence of several sex hormones on tumour growth.…”

Large Mucinous Cystadenoma of the Pancreas During Pregnancy: Report of a Case

“…1,2 Although pregnancy can be complicated by pancreatic neoplasms, MCN associated with pregnancy is extremely rare; only four cases of pancreatic mucinous cystadenoma and two cases of pancreatic mucinous cystadenocarcinoma have been previously reported. [3][4][5][6][7][8] The management of MCN of the pancreas, particularly during pregnancy, is not standardized. The decision whether to observe or to operate can be diffi cult and complicated.…”