Large mucinous cystic neoplasm of the pancreas associated with pregnancy

Abstract

Mucinous cystic neoplasms (MCNs) of the pancreas occur mostly in females and are potentially sex hormone-sensitive. However, a MCN occurring during pregnancy is quite rare. A 30-year-old woman in the tenth week of pregnancy was referred to us because of a rapid increase in left hypochondrial distending pain. On ultrasound, the patient had a large intra-abdominal cystic lesion. She was thereafter diagnosed with missed abortion and a computed tomography scan showed that the lesion was a cystic tumor 18 cm in diameter originating from the pancreatic tail. The patient subsequently underwent tumor resection with distal pancreatectomy, sparing the spleen. Histopathological analysis of the specimen revealed a pancreatic MCN with moderate dysplasia. Immunohistochemically, the tumor was positive for both estrogen and progesterone receptors. To our knowledge, this is the first reported case of pancreatic MCN with moderate dysplasia in association with pregnancy. Our case strongly indicates that pancreatic MCN is female-hormone dependent.

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]). In the majority of these cases, the diagnosis of PMCN was incidental during routine ultrasound evaluation in the first two trimesters of gestation, the tumors being completely asymptomatic.…”

“…However, it remains unclear whether high levels of estrogen and/or progesterone in pregnancy also increase the tumor malignancy potential [10]. In fact, there is evidence that a decrease in progesterone receptor immunoreactivity was correlated with histological or cytological atypicality and a worse prognosis [1].…”

“…PMCNs are almost exclusive to women and may be responsive to female sex hormones [3,10,11]. Thompson et al [3] found that 23% of PMCs are immunopositive for estrogen and 71% for progesterone receptors, some tumors having both types [3,11].…”

“…All patients who were operated during the second trimester of pregnancy experienced an uneventful vaginally delivery at term [6,7,8,9,11,12] resulting in healthy infants, except for one spontaneous abortion at the 10th week of pregnancy [10]. It can be concluded that if tumor resection is performed during the second period of gestation, the best option is a normal vaginal birth.…”

“…Pancreatic surgery was performed 2 or 3 months after delivery. From the other 8 PMCNs reported, 7 were resected in the second trimester of pregnancy [6,7,8,9,10,11,12] and, except for one spontaneous abortion at the 10th week of pregnancy [10], all other patients uneventful vaginally delivered, giving birth to healthy newborns (table 1). The eighth PMCN was ruptured at 34 weeks of pregnancy and imposed an emergency cesarean section, immediately followed by pancreaticoduodenectomy [13].…”