Giant Pancreatic Cyst: An Unusual Entity

Quisto Gigante do Pâncreas: Entidade Pouco Comum

Rita Vale Rodrigues^a,*, Sandra Faias^a, Ricardo Fonseca^b

^aGastroenterology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal

^bPathology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal

Keywords:Endosonography; Pancreatic Cyst

Palavras-chave: Ecoendoscopia; Quisto Pancreático

A 74-year-old woman was referred for further evaluation of a large pancreatic cystic lesion. She presented with abdominal discomfort, without weight loss, anorexia or history of pancreatitis or abdominal trauma. Physical examination revealed a large epigastric mass. A contrast-enhanced computed tomography (CT) showed a huge, well-defined, multiloculated cyst of 12 cm in greatest dimension arising from the pancreatic body, with multiple wall calcifications, without typical imaging features of a particular pancreatic cystic neoplasm (Fig. 1). Endoscopic ultrasound (EUS) showed a multilocular cyst with a larger cyst (120 mm × 70 mm) and a peripheral microcystic component (Fig. 2). EUS-guided fine-needle aspiration of 7 mL of serous cystic fluid was performed from the largest cyst under prophylactic IV antibiotics. The sample had no malignant or mucus-producing cells and CEA (<2.5 ng/mL) and amylase (41 U/L) were within the reference values, making a serous cystadenoma the most likely diagnosis. Due to persistent epigastric discomfort, a distal pancreatectomy and splenectomy was performed (Fig. 3). Macroscopic examination of the resected specimen showed a combination of large cysts with several small cysts. On microscopy, the cysts were lined with a single layer of cuboidal epithelial cells with clear cytoplasm, PAS positive (Fig. 4). Histopathological examination confirmed the diagnosis of a pancreatic serous oligocystic adenoma.

 

 

 

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Serous oligocystic adenoma (SOA) is a rare benign pancreatic tumor which represent an atypical macroscopic morphologic variant of serous cystadenomas (SCA).¹ SOAs are characterized by a limited number of cysts with a diameter of >2 cm and share imaging features overlapping those of mucinous cystic neoplasm (MCN) and branch-duct intraductal papillary mucinous neoplasm (BD-IPMN), thus frequently making the radiologic diagnosis difficult.² Endoscopic ultrasound and cyst fluid aspiration have a role in distinguishing mucinous and serous lesions.³ Management is determined by the presence of symptoms. Giant serous cystadenomas are also rare; this term usually refers to a multicystic tumor larger than 10 cm in diameter in comparison with a described mean tumor diameter of 5 cm.⁴

 

References

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2. Lee JH, Kim JK, Kim TH, Park MS, Yu JS, Choi JY, et al. MRI features of serous oligocystic adenoma of the pancreas: differentiation from mucinous cystic neoplasm of the pancreas. Br J Radiol. 2012;85:571-6.         [ Links ]

3. O’Toole D, Palazzo L, Hammel P, Ben L, Couvelard A, Felce-Dachez M, et al. Macrocystic pancreatic cystadenoma: the role of EUS and cyst fluid analysis in distinguishing mucinous and serous lesions. Gastrointest Endosc. 2004;59:823-9.

4. Galanis C, Zamani A, Cameron JL, Campbell KA, Lillemoe KD, Caparrelli D, et al. Resected serous cystic neoplasms of the pancreas: a review of 158 patients with recommendations for treatment. J Gastrointest Surg. 2007;11:820-6.         [ Links ]

Ethical disclosures

Protection of human and animal subjects. The authors declare that no experiments were performed on humans or animals for this study.

Confidentiality of data. The authors declare that they have followed the protocols of their work center on the publication of patient data.

Right to privacy and informed consent. The authors declare that no patient data appear in this article

Conflicts of interest

^* Corresponding author.

E-mail address: rita.vale.rodrigues@gmail.com (R. V. Rodrigues).

Received 24 December 2015; accepted 9 February 2016