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

Abstract

Pancreatic mucinous cystic neoplasms are uncommon and their occurrence in pregnancy is extremely rare. The authors report the unique case of a newborn weighing 3,620 g, delivered vaginally with no complications by a patient with a large ‘silent' pancreatic mucinous cystic neoplasms, and analyze the very few other reports. With no available protocol, this case highlights an interesting dilemma on the management of pregnancy and delivery as well on the timing of pancreatic surgery. Despite its limitations, MRI remains the most accurate investigation either for differentiating the mucinous from nonmucinous cysts or for evaluating the malignancy, but echography is also very useful. Without symptoms, all low-grade malignant potential tumors, independent of the moment of their diagnosis during pregnancy, should be resected 2-3 months after delivery and we believe that the best option is a term vaginal birth, even in the presence of a large cyst and large fetus. On the contrary, all high-grade malignant potential tumors, discovered in the first two trimesters of pregnancy should be resected during the second trimester, and followed by a vaginal delivery at term. If high-grade malignant potential tumor is diagnosed in the third trimester, an early vaginal delivery followed by surgery is recommended. Finally, the patient's preference is crucial.

The Pathological Features and Prognoses of Intraductal Papillary Mucinous Neoplasm and Mucinous Cystic Neoplasm After Surgical Resection: A Single Institution Series

“…The characteristic subepithelial tissue of MCN is ovarian-type stroma. MCN occurs almost exclusively in middle-aged women and some studies have linked it to pregnancy and hormone-replacement therapy [28][29][30].In our study, only 6 patients (22.2%) developed MCN during or shortly after pregnancy, but it was enough to conclude that MCN may be hormonally in uenced. The role of hormones in the formation and malignant transformation of MCN needs to be further studied, which may affect the management of MCN in pregnant and postmenopausal patients.…”

Challenges in the management of adenocarcinoma of ampulla of Vater in pregnancy: A case report and review of literature

“… Liu et al [ 37 ] Adenocarcinoma 31 weight loss and progressive, positional dyspnea 3rd trimester US, CT, PET scan 3rd (34) Ovarian cyst rupture, (post-op) Pleural effusion, ascites Tsuda et al [ 38 ] MCN 28 Referred as case of abdominal tumor 1st (9) US, MRI, 2nd (18) Mild glucose intolerance post-op. Tica et al [ 39 ] MCN 27 abnormal sonogram 3rd (29) MRI postpartum No complications Huang et al [ 40 ] SPNs 29 Epigastric pain, backache, nausea, and vomiting 2nd (19) US, MRI 2nd (19) Tumor rupture MacDonald et al [ 41 ] SPNs 23 Incidentally abdominal mass by US 2nd (14) US, MRI 2nd (18) No complications Labarca-Acosta et al [ 42 ] Adenocarcinoma 35 Vomiting, pain in the left epigastrium and hypochondrium, general weakness and weight loss. 16 weeks Fine-needle biopsy – Maternal death Aker et al [ 43 ] Adenocarcinoma 27 …”

A huge ovarian mucinous cystadenoma causing virilization, preterm labor, and persistent supine hypotensive syndrome during pregnancy

“…However, MCs from ectopic ovarium tissue in organs, such as the omentum, appendix, or pancreas, have also been reported. 14 , 15 The origin or the pathogenesis of MCs in other organs is not yet well defined. Theories suggest that: (i) MC may be the result of ectopic ovarian tissue or teratoma; and (ii) MC may result from a peritoneal invagination and therefore form a cyst with further mesothelium mucinous metaplasia.…”