Mucinous cystadenoma of the pancreas resected 11 years after cystgastrostomy

Abstract

There have been numerous reports that mucinous cystadenoma of the pancreas can transform to mucinous cystadenocarcinoma after cystenterostomy, but few authors have reported morphological changes long after cystenterostomy for mucinous cystadenoma. A 41-year-old Japanese woman had undergone cystgastrostomy at a nearby hospital 11 years before undergoing the treatment reported here. The preoperative diagnosis at the time of cystgastrostomy was a pancreatic cyst. At laparotomy a cyst, measuring 10cm in diameter, was found in the body and tail of the pancreas. The histopathological diagnosis of the cyst wall was mucinous cystadenoma of mild dysplasia. Computed tomography 10 years after the cystgastrostomy showed that the cyst had decreased in diameter from 10 cm to 5cm. Gastroscopy showed a scar at the cystgastrostomy site in the stomach. A complete resection of the mucinous cystadenoma was done, 11 years after the cystgastrostomy, because of the malignant potential. The resected specimen showed mucinous cystadenoma of mild dysplasia with structural and cellular atypia similar to that in the previous specimen. There was no malignant change. The patient was discharged after an uneventful postoperative course and no recurrence has been evident for 6 months to date. This case showed imaging and histopathological evidence of the slow-growing nature of mucinous cystadenoma of the pancreas.

Palliative endoscopic ultrasound-guided drainage of a malignant pancreatic cyst causing gastric outlet obstruction

“…Rarely, surgical internal drainage has been reported for cystic pancreatic neoplasm [7] . However, in most series drainage was only performed when the cystic lesion was misdiagnosed as a pseudocyst [7][8][9][10][11] .…”

“…Subsequent surgical resection was performed when the diagnosis was corrected [7] . Further series also described the accidental drainage of mucinous neoplasms mistaken for pseudocysts [8][9][10][11] . To our knowledge, no prior reports of intentional palliative EUS-guided drainage of malignant pancreatic cysts have been described in the English literature.…”