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

Abstract

A 33-year-old woman, gravida 2, para 1, was diagnosed to have a benign mucinous cystic neoplasm of the pancreas 5 months before delivery. The tumor measured 12 cm in diameter at the time of diagnosis. The antenatal course was uneventful, and a vaginal delivery produced a normal infant. By 2 months after delivery, the tumor reached 18 cm. At surgery, a huge cyst was found to originate from the pancreas, and a distal pancreatectomy with splenectomy was performed. The cystic mass was multilocular 18 x 17 x 12 cm, 2450 g, and red to yellowish-gray. The histologic diagnosis was benign mucinous cystadenoma. The postoperative course was uneventful, and the patient remains free of recurrence at 7 months after surgery. To our knowledge, this is only the fifth reported case of pancreatic mucinous cystadenoma in association with pregnancy. This is the first reported case of a successful resection of such a tumor after delivery.

Large Pancreatic Mucinous Cystic Neoplasm during Pregnancy: What Should Be Done?

“…In the English literature there are only two reports of patients who delivered vaginally at term [4,5], and in 1 case the tumor was discovered only 2 months after delivery [5]. Of the other 8 PMCNs reported, 7 were resected during the second trimester of pregnancy [6,7,8,9,10,11,12] and one at 34 weeks (due to cyst rupture [13]).…”

“…Transabdominal fine-needle aspiration is debatable due to the risk of tumor cell seeding [4]. Even if, theoretically, a fine-needle aspiration is done, cytology, tumor markers (CEA, CA 19-9, CA 15-3, CA 72-4, CA 125), enzymes (amylase, lipase) as well as DNA analysis (loss of heterozygosity - LOH and K-ras mutations) from the cyst fluid, have a specificity which varies considerably in different studies [14,20].…”

“…PMCNs occur almost exclusively in females, being considered potentially sex hormone sensitive [3], but their association with pregnancy is an extremely rare phenomenon. To the best of our knowledge, only 2 patients delivered vaginally at term [4,5], with one of the tumors diagnosed only in the postpartum period [5]. Pancreatic surgery was performed 2 or 3 months after delivery.…”

Large mucinous cystic neoplasm of the pancreas associated with pregnancy

“…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.…”