Pancreatic microcystic serous cystadenoma: a lethal disease? Rare case of a life-threatening haemorrhage

Abstract

Serous pancreatic cystadenomas are benign tumours and most cases are detected incidentally. Complications are unusual. A patient with a history of a large pancreatic serous cystadenoma (SCA) presented to the emergency department with abdominal pain and haemodynamic shock. After haemodynamic stabilisation, an urgent abdominal CT scan revealed a large hemoperitoneum but the origin of the bleeding was not found. The patient was submitted to an angiography that revealed a bleeding hypervascular pancreatic mass and an embolisation was done successfully. After 3 weeks, the patient underwent a laparotomic left pancreatectomy with en bloc splenectomy. The anatomopathological results were consistent with a microcystic SCA of the pancreas. Despite the high vascularity of pancreatic SCA, haemorrhage is a very rare but life-threatening complication.

Massive pancreatic serous cystadenomas raise important questions regarding surgical management of incidental pancreatic cystic lesions: a report of two cases

“…However, there is still risk for missed malignancies such as the neuroendocrine carcinoma discovered on surgical pathology of the second patient presented here and similar to one reported by Yadav et al ( 15 ). Additional rationale behind early intervention includes reducing risk of non-operative complications such as pain, early satiety, biliary obstruction, atrophy of normal pancreatic parenchyma leading to exocrine and endocrine dysfunction, and erosion of tumor vessels resulting in catastrophic hemorrhage ( 16 - 19 ). When juxtaposed the AGA, ACG, European, and IAP guidelines, this suggests a possible discrepancy in the perspectives of medical and surgical management of benign pancreatic lesions.…”

Endovascular treatment of haemorrhagic pancreatic serous cystadenoma

“…Only three cases of hemoperitoneum secondary to pancreatic SC have been reported in the literature (Amaral et al 2020 ; Ashkzaran et al 2007 ; Cha et al 2021 ). The first patient was treated by embolization followed by surgery (Amaral et al 2020 ), the second one was treated by surgery alone (Ashkzaran et al 2007 ), and both showed no malignancy on microscopic evaluation. The third one also had surgical resection, and synchronous pancreatic neoplasm was found out in pathology, so surgery should be recommended when possible (Cha et al 2021 ).…”

Triple Threat; pancreatic cystic lesion presenting with spontaneous hemorrhage is found to harbor three distinct neoplasms.

“…There have only been a few cases of hemorrhage related to SCA reported based on our literature search. In two case reports, patients presented with an acute abdomen from hemorrhage, and both patients underwent distal pancreatectomy of large cysts with diameter > 10 cm [7][8]. While rare, hemorrhage associated with SCA may be life threatening and requires prompt identi cation and surgical intervention.…”

“…In rare cases, giant SCA may cause splenic vein compression leading to gastric varices or obstructive jaundice requiring surgical resection [5,6]. A spontaneous hemorrhage from SCA is extremely rare, with only a few reported cases in literature [7][8][9], and as such, the threat of bleeding has not signi cantly in uenced treatment or surveillance algorithms.…”

“…Spontaneous hemorrhage related to SCA is an extremely rare event, with only a few reported cases in literature [7][8][9], and as such, the threat of bleeding has not signi cantly in uenced treatment or surveillance algorithms.…”