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Abdominal CT revealed a multilocular cyctic mass, 6.3 cm in diameter, with wall calcification and no solid component in the pancreatic tail.
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Figure 1: Abdominal CT revealed a multilocular cyctic mass, 6.3 cm in diameter, with wall calcification and no solid component in the pancreatic tail.

Mentions: A 39-year-old man was admitted to our hospital with the chief complaint of back pain. There was no history of previous abdominal imaging examinations, and another abdominal episode, such as sudden abdominal pain, abdominal trauma, or abdominal operation. He was just social drinker of alcohol and was not smoker. On physical examination, abdomen was soft and flat, and no tenderness was noticed. Laboratory tests showed an elevation of both AST, up to 39 IU/l (normal≦35 IU/L), and ALT,up to 56 IU/L (normal≦40 IU/L). The other data including tumor markers (CEA, CA19-9 and DUPAN-2) were within normal range. Abdominal CT revealed a multilocular cyctic mass, 6.3 cm in diameter, with wall calcification in the pancreatic tail (Figure 1). On MRI, the cystic lesion was hypointense in T1-weighted imaging and hyperintense in T2-weighted imaging with low intense capsule and septum (Figure 2 a,b). ERCP showed neither communication between the cystic lesion and the main pancreatic duct nor encasement nor interruption of the main pancreatic duct. Endoscopic ultrasonography revealed neither solid component nor thickness of the septae in the cystic lesion. Consequently, under the diagnosis of neoplastic cyst of the pancreas, such as lymph epithelial cyst, serous cystic neoplasm, branched-type lesion of IPMN, cystic change of endocrine tumor, and epidermoid cyst derived from accessory spleen in the pancreas, distal pancreas with spleen was removed. Macroscopically (Figure 3), the cystic lesion, measuring for 6.5×5.8×5.2 cm in size, was round with a smooth surface and was surrounded by normal pancreatic tissue. The cut surface demonstrated a multilocular cystic pattern containing thick yellowish mucin, and the lesion was surrounded by a fibrous capsule. There was neither mural nodule nor papillary projections inside the cystic lesion. Microscopically (Figure 4 a,b), the cystic lesion showed two distinct component; an inner mucinous epithelial layer and an outer densely cellular stromal layer. The mucinous epithelium showed no cytological atypia and did not infiltrate into the stromal layer. This stromal layer was consisted of spindle-shaped cells with round to oval nucrei and a small amount of cytoplasm, suggesting the finding for OS. From the immune-histopathological staining, the stromal layer was detected for negative on both estrogen and/or progesterone receptors.

Mucinous cystic neoplasm of the pancreas in a male patient

Tokuyama Y, Osada S, Sanada Y, Takahashi T, Yamaguchi K, Yoshida K - Rare Tumors (2011)

Bottom Line: Endoscopic retrograde cholangio-pancreatography (ERCP) showed neither communication between the cystic lesion and the main pancreatic duct nor encasement of the main pancreatic duct.Endoscopic ultrasonography revealed neither solid component nor thickness of the septae in the cystic lesion.Based on these findings, the cystic lesion was diagnosed as MCN.

Affiliation: Department of Surgical Oncology, Graduate School of Medicine, Gifu University, Gifu, Japan.

ABSTRACT
Mucinous cystic neoplasms (MCNs) make up a morphologic family of similar appearing tumors arising in the ovary and various extraovarian organs such as pancreas, hepatobiliary tract and mesentery. MCNs of the pancreas occur almost exclusively in women. Here, we report a rare case of MCN in a male patient. A 39-year-old man was admitted to our hospital with the chief complaint of back pain. Abdominal computed tomography revealed a multilocular cyctic mass 6.3 cm in diameter in the pancreatic tail. In addition, the outer wall and septae with calcification were demonstrated in the cystic lesion. On magnetic resonance imaging , the cystic fluid had low intensity on T1-weighted imaging and high intensity on T2-weighted imaging. Endoscopic retrograde cholangio-pancreatography (ERCP) showed neither communication between the cystic lesion and the main pancreatic duct nor encasement of the main pancreatic duct. Endoscopic ultrasonography revealed neither solid component nor thickness of the septae in the cystic lesion. Consequently, we performed distal pancreatectomy with splenectomy under the diagnosis of cystic neoplasia of the pancreas. Histopathologically, the cystic lesion showed two distinct component: an inner epithelial layer and an outer densely cellular ovarian-type stromal layer. Based on these findings, the cystic lesion was diagnosed as MCN.

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