Endoscopy 2013; 45(S 02): E36-E37
DOI: 10.1055/s-0032-1325888
Cases and Techniques Library (CTL)
© Georg Thieme Verlag KG Stuttgart · New York

A case of mucinous cystadenocarcinoma of the pancreas with spontaneous rupture diagnosed by endoscopic retrograde pancreatography

A. Imoto
1  Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan
,
D. Masuda
1  Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan
,
Y. Kurisu
2  Department of Pathology, Osaka Medical College, Takatsuki, Osaka, Japan
,
S. Onda
1  Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan
,
T. Ogura
1  Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan
,
M. Takii
1  Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan
,
E. Umegaki
1  Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan
,
M. Hayashi
3  Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
,
K. Uchiyama
3  Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
,
K. Higuchi
1  Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan
› Author Affiliations
Further Information

Corresponding author

A. Imoto, MD
Second Department of Internal Medicine
Osaka Medical College
Takatsuki
Osaka 569-8686
Japan   
Fax: +81-726-84-6423   

Publication History

Publication Date:
22 March 2013 (online)

 

Mucinous cystic neoplasm (MCN) of the pancreas is characterized by a multilocular cystic lesion lined by mucin-producing columnar epithelium and an ovarian-type stroma [1]. MCNs are often found incidentally and may occasionally cause symptoms. Rupture of a pancreatic MCN is a rare complication, and only a few cases have been reported to date [2] [3] [4] [5]. Many of these cases occurred during pregnancy [2] [3] [5]. This report is the first to describe a case of ruptured MCN with an associated invasive carcinoma of the pancreas diagnosed by endoscopic retrograde pancreatography (ERP).

In a 69-year-old woman complaining of abdominal pain, contrast-enhanced computed tomography (CT) showed a low-density mass 60 mm in diameter that communicated with a dilated main pancreatic duct ([Fig. 1]). Contrast-enhanced endoscopic ultrasound (EUS) revealed a mixed-echo pattern in the mass and enhancement effects in hyperechoic areas ([Fig. 2]). The findings on CT, EUS, and magnetic resonance imaging (not shown) suggested that the tumor was a multilocular cystic lesion of the pancreas with solid components, but they were atypical, and a diagnosis could not be reached. ERP was then performed and showed leakage of contrast medium from the main pancreatic duct into the peritoneal cavity ([Fig. 3]). CT images obtained immediately after ERP showed pooling of contrast medium in the peritoneal cavity around the tumor ([Fig. 4]). A body-tail pancreatectomy with splenectomy was performed quasi-emergently 5 days after ERP. The definitive pathological diagnosis was mucinous cystadenocarcinoma of the pancreas with foci of ovarian-like stroma ([Fig. 5]). After surgery, the patient underwent chemotherapy with 5-fluorouracil and has remained symptom-free, with no detectable tumor recurrence at present, 2 months after surgery.

Zoom Image
Fig. 1 Computed tomography shows the presence of a low-density mass in the pancreatic body that communicates with a dilated main pancreatic duct.
Zoom Image
Fig. 2 Contrast-enhanced endoscopic ultrasound shows a mixed-echo pattern in the mass and enhancement effects in hyperechoic areas.
Zoom Image
Fig. 3 Endoscopic retrograde pancreatography shows rupture of the tumor. Leaked contrast medium from the main pancreatic duct is pooling around the intestinal tract. Scale bar: 1 cm.
Zoom Image
Fig. 4 Pooling of contrast medium is seen in the peritoneal cavity around the tumor.
Zoom Image
Fig. 5 Histological sections showed thickened mucinous epithelium and ovarian-type stroma (hematoxylin and eosin; magnification × 200). Scale bar: 50 μm.

To the best of our knowledge, this is the first report of MCN of the pancreas with spontaneous rupture diagnosed by ERP.

Endoscopy_UCTN_Code_CCL_1AZ_2AB


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Competing interests: None


Corresponding author

A. Imoto, MD
Second Department of Internal Medicine
Osaka Medical College
Takatsuki
Osaka 569-8686
Japan   
Fax: +81-726-84-6423   


Zoom Image
Fig. 1 Computed tomography shows the presence of a low-density mass in the pancreatic body that communicates with a dilated main pancreatic duct.
Zoom Image
Fig. 2 Contrast-enhanced endoscopic ultrasound shows a mixed-echo pattern in the mass and enhancement effects in hyperechoic areas.
Zoom Image
Fig. 3 Endoscopic retrograde pancreatography shows rupture of the tumor. Leaked contrast medium from the main pancreatic duct is pooling around the intestinal tract. Scale bar: 1 cm.
Zoom Image
Fig. 4 Pooling of contrast medium is seen in the peritoneal cavity around the tumor.
Zoom Image
Fig. 5 Histological sections showed thickened mucinous epithelium and ovarian-type stroma (hematoxylin and eosin; magnification × 200). Scale bar: 50 μm.