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

Abstract

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 [2–5]. 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 lowdensitymass60mm indiameter that communicated with a dilated main pancreatic duct (● Fig.1). Contrast-enhanced endoscopic ultrasound (EUS) revealed amixedechopattern in themassandenhancement effects in hyperechoic areas (● Fig.2). The findings on CT, EUS, and magnetic resonance imaging (not shown) suggested that the tumorwas amultilocular 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 quasiemergently 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. To the best of our knowledge, this is the first report of MCN of the pancreas with spontaneous rupture diagnosed by ERP.