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Mucinous cystic neoplasm

Knaus CMK - MedPix (2013)

View Article: MedPix Image - MedPix Case

Affiliation: Walter Reed National Military Medical Center

ABSTRACT

Diagnosis: Mucinous cystic neoplasm

History: This 36 yo woman presents to the ED with severe upper back pain, nausea, four episodes of bilious vomiting, fevers, chills, and headaches. The pain, which woke her from sleep, includes the majority of her back, left more than right, from the mid-scapulae to the middle of her back. She denied any SOB or dizziness. She endorsed having regular bowel movements and urination and that her LMP was one week ago. Denies being pregnant and said she had two recent pregnancy tests, which were negative. PMHx: h/o gallstone pancreatitis in 2006 PSHx: cholecystectomy 2006 Breast reduction

Findings: 1. Large complex cystic lesion in the left upper quadrant which appears to arise from the pancreas and has an appearance of a mucinous cystic tumor with differential considerations given to solid and papillary neoplasm and cystic metastatic disease. 2. Separate, nonenhancing cystic lesion in the posterior mediastinum at the level of the esophageal hiatus which may represent an enteric duplication cyst versus metastatic focus. 3. Gastric varices/portosystemic collateral vessels, mild central intrahepatic biliary ductal dilatation and delayed left nephrogram likely secondary to mass effect from dominant mass in the abdomen.

Ddx: - Mucinous cystic tumor - Solid and papillary neoplasm - Cystic metastatic disease

Dxhow: Pathology of biopsy during urgent laproscopy

Exam: Vitals - HR 91-128, BP 109/68, T 97.8-99.4, Tc 98.4, RR 14-21, SaO2 97%ra. Gen - NAD, pleasant, cooperative HEENT - PERRL, EOMI, no scleral icterus. CV - tachycardic, nml S1/S2, 2/6 systolic flow murmur. Lungs - CTA B/L, no wheezes/crackles Abdo - Diminished bowel sounds, soft with large LUQ mass - firm, smooth, occupying entire LUQ and encroaching on RUQ, nontender Extr - no LE edema, 2+ pulses x4

No MeSH data available.


MCNs typically are noninvasive but can be invasive and this is actually suspected in this case.  There is a small ductule that is formed by malignant appearing cells with what appears to be a focus of intraluminal necrosis.
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MPX2411_synpic58814: MCNs typically are noninvasive but can be invasive and this is actually suspected in this case. There is a small ductule that is formed by malignant appearing cells with what appears to be a focus of intraluminal necrosis.


Mucinous cystic neoplasm

Knaus CMK - MedPix (2013)

MCNs typically are noninvasive but can be invasive and this is actually suspected in this case.  There is a small ductule that is formed by malignant appearing cells with what appears to be a focus of intraluminal necrosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX2411&req=5

MPX2411_synpic58814: MCNs typically are noninvasive but can be invasive and this is actually suspected in this case. There is a small ductule that is formed by malignant appearing cells with what appears to be a focus of intraluminal necrosis.

View Article: MedPix Image - MedPix Case

Affiliation: Walter Reed National Military Medical Center

ABSTRACT

Diagnosis: Mucinous cystic neoplasm

History: This 36 yo woman presents to the ED with severe upper back pain, nausea, four episodes of bilious vomiting, fevers, chills, and headaches. The pain, which woke her from sleep, includes the majority of her back, left more than right, from the mid-scapulae to the middle of her back. She denied any SOB or dizziness. She endorsed having regular bowel movements and urination and that her LMP was one week ago. Denies being pregnant and said she had two recent pregnancy tests, which were negative. PMHx: h/o gallstone pancreatitis in 2006 PSHx: cholecystectomy 2006 Breast reduction

Findings: 1. Large complex cystic lesion in the left upper quadrant which appears to arise from the pancreas and has an appearance of a mucinous cystic tumor with differential considerations given to solid and papillary neoplasm and cystic metastatic disease. 2. Separate, nonenhancing cystic lesion in the posterior mediastinum at the level of the esophageal hiatus which may represent an enteric duplication cyst versus metastatic focus. 3. Gastric varices/portosystemic collateral vessels, mild central intrahepatic biliary ductal dilatation and delayed left nephrogram likely secondary to mass effect from dominant mass in the abdomen.

Ddx: - Mucinous cystic tumor - Solid and papillary neoplasm - Cystic metastatic disease

Dxhow: Pathology of biopsy during urgent laproscopy

Exam: Vitals - HR 91-128, BP 109/68, T 97.8-99.4, Tc 98.4, RR 14-21, SaO2 97%ra. Gen - NAD, pleasant, cooperative HEENT - PERRL, EOMI, no scleral icterus. CV - tachycardic, nml S1/S2, 2/6 systolic flow murmur. Lungs - CTA B/L, no wheezes/crackles Abdo - Diminished bowel sounds, soft with large LUQ mass - firm, smooth, occupying entire LUQ and encroaching on RUQ, nontender Extr - no LE edema, 2+ pulses x4

No MeSH data available.