A case of a pancreatic pseudocyst associated with alcoholic chronic pancreatitis that mimicked a mucinous cystic neoplasm.
Koji Takao, Hiromitsu Maehira, Haruki Mori et al.
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Case in brief
A 64-year-old woman with alcoholic liver cirrhosis had a progressively enlarging cyst in the pancreatic body and elevated serum carbohydrate antigen 19-9. CT showed a multilocular lesion with calcification, thickened septa, and a protruding component; endoscopic ultrasonography showed blood flow within the protrusion and no apparent communication with the main pancreatic duct. Parenchymal features suggested chronic pancreatitis, but mucinous cystic neoplasm with possible malignancy was diagnosed, and distal pancreatectomy with splenectomy was performed. Histology showed surrounding fibrosis, fibrin and material suggestive of pancreatic stones, no cyst-wall epithelial lining, and ductal communication, establishing a pseudocyst.
What made this case unusual
The pseudocyst had several features that suggested mucinous cystic neoplasm, including a protruding, vascular component, multilocularity, calcification, and elevated carbohydrate antigen 19-9, creating diagnostic uncertainty despite evidence of chronic pancreatitis.
Diagnostic / clinical pearl
In a patient with chronic pancreatitis, imaging and serum-marker features suggestive of mucinous cystic neoplasm may not exclude a pseudocyst; histology in this case established the diagnosis through absent epithelial lining and ductal communication.