Adenoma seroso oligoquístico do pâncreas - a propósito de um caso clínico

N. Almeida¹, S. Alves¹, I. Borges², C. Gregório¹, D. Gomes¹, F. Portela¹, M. Sérgio², M. Rui³, M. Urbano⁴, H. Gouveia¹, F. Martinho², D. Freitas¹

 

Resumo

Apresentamos o caso clínico de um doente de cinquenta anos que recorreu ao Serviço de Urgência por queixas de epigastralgias com três meses de evolução, sem antecedentes de pancreatite e sem hábitos etílicos. A ecografia abdominal a que foi submetido mostrou uma lesão quística do pâncreas confirmada pela TAC mas cuja natureza não foi possível esclarecer mesmo após punção eco-guiada. O doente foi submetido a duodenopancreatectomia cefálica radical, após biopsia extemporânea inconclusiva, mas o estudo anatomo-patológico da peça operatória revelou um adenoma seroso oligoquístico com alguns fenómenos de pancreatite crónica obstrutiva.

Trata-se de uma situação rara e embora a hipótese de cistadenoma seroso não tivesse sido excluída ab initio era das que se apresentava como menos provável.

 

Summary

We present the case of a fifty years old patient who was first seen in the Emergency Service with a three month history of epigastric pain, without previous pancreatitis or alcohol consumption. The abdominal ultrasound has shown a cystic lesion of the pancreas confirmed by CT scan. However, its ethiology was not determined even after ultrasound guided aspiration of the cyst fluid. The patient was submitted to cephalic pancreatoduodenectomy (Whipple's resection) after an inconclusive extemporaneous biopsy but the histological observation of the surgical specimen revealed a serous oligocystic adenoma with some features of obstructive chronic pancreatitis.

This is a rare condition and although the hypothesis of serous cystadenoma was not excluded “ab initio”, it was one of the least probable.

 

 

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Bibliografia

1. Shami VM, Benign Cysts: Pseudocysts. In: Wang KK, Waxman I, eds. Endoscopic Surgery; endoscopy for the next millennium – a Maio/Junho 2006 ADENOMA SEROSO OLIGOQUÍSTICO DO PÂNCREAS 151 problem based approach. ASGE Annual Postgraduate Course 2004        [ Links ]

2. Warshaw A, Compton C, Lewandrowski K, et al. Cystic tumors of the pancreas: New clinical, radiologic and pathologic observations in 67 patients. Ann Surg 1990; 212: 432-45.

3. Férnandez-del Castillo C, Jimenez RE. Pancreatic Cancer, Cystic Pancreatic Neoplasms and other Nonendocrine Pancreatic Tumors (Chapter 50). In: Feldman M, Friedman LS, Sleisenger MH, eds. Gastrointestinal and Liver Disease. 7th Edition. Saunders; 2002. p. 970-87.

4. Brugge WR, Lauwers GY, Sahani D, Fernandez-del Castillo C,  Warshaw AL. Cystic Neoplasms of Pancreas. N Engl J Med 2004;351;1218-26.

5. Santos LD, Chow C, Henderson CJA, Blomberg DN, Merrett ND, Kennerson AR, et al. Serous oligocystic adenoma of the pancreas: a clinicopathological and immunohistochemical study of three cases with ultrastructural findings. Pathology 2002; 34: 148-56.

6. Brugge WR, Lewandrowski K, Lee-Lewandroski E, Centeno BA, Szydlo T, Regan S, Férnandez del Castillo C, et al. Diagnosis of Pancreatic Cystic Neoplasms: A Report of the Cooperative Pancreatic Cyst Study. Gastroenterology 2004; 126:1330-36

7. Spinelli KS, Fromwiller TE, Daniel RA, Kiely JM, Nakeeb A, Komorowski RA, et al. Cystic Pancreatic Neoplasms: Observe or Operate? Ann Surg. 2004; 239: 651-59

8. Curry CA, Eng J, Hortton KM, et al. CT of primary cystic pancreatic neoplasms: can CT be used for patient triage and treatment. Am J Roentgenol. 2000; 175: 99-103

9. Kiely JM, Nakeeb A, Komorowski RA, et al. Cystic pancreatic neoplasms: enucleate or ressect? J Gastrointest Surg. 2003; 7:890-7

10. Abe H, Kubota K, Mori M, et al. Serous cystadenoma of the pancreas with invasive growth: Benign or malignant? Am J Gastroenterol 1998; 93: 1963-66

11. Alpert LC, Truong LD, Bossart MI, Spjut HJ. Microcystic adenoma (serous cystadenomas) of the pancreas: a study of 14 cases with immunohistochemical and electron-microscopic correlation. Am J Surg Pathol 1988; 12: 251-63

12. Howard JM. Cystic neoplasms and true cysts of the pancreas. Surg Clin North Am 1989; 69: 651-65

13. Frossard JL, Amouyal P, Amouyal G, Palazzo L, Amaris J, Soldan M, et al. Performance of Endosonography-Guided Fine Needle Aspiration and Biopsy in the Diagnosis of Pancreatic Cystic Lesions. Am J Gast 2003; 98, 7: 1516-24

14. Talamini MA, Moesinger R, Yeo CJ, et al. Cystadenomas of the pancreas: Is enucleation an adequate operation? Ann Surg 1997;227:896-903

15. Pyke CM, Heerden JV, Colby TV, Sarr MG, Weaver AL. The spectrum of serous cystadenoma of the pancreas: Clinical, Pathologic and Surgical aspects. Ann Surg 1992; 215: 132-9

 

(1) Serviço de Gastrenterologia dos HUC, Coimbra, Portugal.

(2) Serviço de Cirurgia 2 dos HUC, Coimbra, Portugal.

(3) Serviço de Anatomia Patológica dos HUC, Coimbra, Portugal.

(4) Investigadora Auxiliar da Faculdade de Medicina de Coimbra,

Coimbra, Portugal.