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Ectopic pancreatic pseudocyst and cyst presenting as a cervical and mediastinal mass: case report and review of the literature.

Rokach A, Izbicki G, Deeb M, Bogot N, Arish N, Hadas-Halperen I, Azulai H, Bohadana A, Golomb E - Diagn Pathol (2013)

Bottom Line: We reviewed the case reports describing this rare condition in the medical literature.We conclude that the possibility of ectopic pancreatic tissue should be included in the differential diagnosis of anterior mediastinal cystic mass, though as a remote possibility.Posterior mediastinal pseudocyst is a different entity associated with acute pancreatitis.Our third conclusion is that pancreatic tissue should be actively sought, if a structure resembling a pseudocyst is found in an unexpected location.

View Article: PubMed Central - HTML - PubMed

Affiliation: The Institute of Pulmonology, Shaare Zedek Medical Center, Jerusalem, Israel. izbicki@szmc.org.il.

ABSTRACT

Unlabelled: Ectopic pancreas in the mediastinum is extremely rare. We are reporting on a case of a twenty two year old woman who presented to our clinic with a large cervical mass. The CT scan revealed a cystic lesion in the anterior mediastinum. The patient underwent surgical resection by cervical approach. A Cystic mass with pseudocysts, cysts and complete pancreatic tissue were found in pathology. There were no signs of pancreatitis or malignancy. No recurrence was observed after a follow up of four years. We reviewed the case reports describing this rare condition in the medical literature.We conclude that the possibility of ectopic pancreatic tissue should be included in the differential diagnosis of anterior mediastinal cystic mass, though as a remote possibility. Surgery is probably needed for the diagnosis and treatment. Posterior mediastinal pseudocyst is a different entity associated with acute pancreatitis. In those cases surgery is not recommended. Our third conclusion is that pancreatic tissue should be actively sought, if a structure resembling a pseudocyst is found in an unexpected location.

Virtual slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1849369005957671.

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Related in: MedlinePlus

Computed tomography images. Axial Computed Tomography images at the level of the thoracic inlet, show two adjacent cystic lesions, one in the anterior lower neck (A) measuring 3.8×2.3×5.1 cm and one in the anterior mediastinum on the left (B), measuring 2.7×2.2×1.8 cm. On coronal reconstruction (C) the neck lesion is shown as a lobular cystic mass with smooth enhancing rim. There is a speck of calcification at the cyst's wall (A, arrow).
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Figure 1: Computed tomography images. Axial Computed Tomography images at the level of the thoracic inlet, show two adjacent cystic lesions, one in the anterior lower neck (A) measuring 3.8×2.3×5.1 cm and one in the anterior mediastinum on the left (B), measuring 2.7×2.2×1.8 cm. On coronal reconstruction (C) the neck lesion is shown as a lobular cystic mass with smooth enhancing rim. There is a speck of calcification at the cyst's wall (A, arrow).

Mentions: An otherwise healthy twenty two year old woman was sent to our hospital because of a left cervical mass. The mass was soft without tenderness and with no symptoms like chest pain, dyspnea or cough. The physical examination was unremarkable except the cervical mass. Blood tests including complete blood count, electrolytes and thyroid function tests were within the normal range. Cervical ultrasound revealed a left supraclvicular hypoechogenic lesion (2.4×3.8 cm). Chest computed tomography demonstrated a cystic mass in the anterior mediastinum protruding to the left cervical region, close to the left common carotid artery (Figure 1). Fine needle aspiration showed inflammatory cells without specific diagnosis and no signs of malignancy. Surgical resection was carried out by cervical approach. Pathology examination showed cystic masses along with pseudo cysts and a complete pancreatic tissue (including endocrine and exocrine tissue). There were no signs of malignancy (Figure 2). Surgical follow-up was uneventful. Four years after the operation the patient feels well with no signs of recurrence.


Ectopic pancreatic pseudocyst and cyst presenting as a cervical and mediastinal mass: case report and review of the literature.

Rokach A, Izbicki G, Deeb M, Bogot N, Arish N, Hadas-Halperen I, Azulai H, Bohadana A, Golomb E - Diagn Pathol (2013)

Computed tomography images. Axial Computed Tomography images at the level of the thoracic inlet, show two adjacent cystic lesions, one in the anterior lower neck (A) measuring 3.8×2.3×5.1 cm and one in the anterior mediastinum on the left (B), measuring 2.7×2.2×1.8 cm. On coronal reconstruction (C) the neck lesion is shown as a lobular cystic mass with smooth enhancing rim. There is a speck of calcification at the cyst's wall (A, arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3817996&req=5

Figure 1: Computed tomography images. Axial Computed Tomography images at the level of the thoracic inlet, show two adjacent cystic lesions, one in the anterior lower neck (A) measuring 3.8×2.3×5.1 cm and one in the anterior mediastinum on the left (B), measuring 2.7×2.2×1.8 cm. On coronal reconstruction (C) the neck lesion is shown as a lobular cystic mass with smooth enhancing rim. There is a speck of calcification at the cyst's wall (A, arrow).
Mentions: An otherwise healthy twenty two year old woman was sent to our hospital because of a left cervical mass. The mass was soft without tenderness and with no symptoms like chest pain, dyspnea or cough. The physical examination was unremarkable except the cervical mass. Blood tests including complete blood count, electrolytes and thyroid function tests were within the normal range. Cervical ultrasound revealed a left supraclvicular hypoechogenic lesion (2.4×3.8 cm). Chest computed tomography demonstrated a cystic mass in the anterior mediastinum protruding to the left cervical region, close to the left common carotid artery (Figure 1). Fine needle aspiration showed inflammatory cells without specific diagnosis and no signs of malignancy. Surgical resection was carried out by cervical approach. Pathology examination showed cystic masses along with pseudo cysts and a complete pancreatic tissue (including endocrine and exocrine tissue). There were no signs of malignancy (Figure 2). Surgical follow-up was uneventful. Four years after the operation the patient feels well with no signs of recurrence.

Bottom Line: We reviewed the case reports describing this rare condition in the medical literature.We conclude that the possibility of ectopic pancreatic tissue should be included in the differential diagnosis of anterior mediastinal cystic mass, though as a remote possibility.Posterior mediastinal pseudocyst is a different entity associated with acute pancreatitis.Our third conclusion is that pancreatic tissue should be actively sought, if a structure resembling a pseudocyst is found in an unexpected location.

View Article: PubMed Central - HTML - PubMed

Affiliation: The Institute of Pulmonology, Shaare Zedek Medical Center, Jerusalem, Israel. izbicki@szmc.org.il.

ABSTRACT

Unlabelled: Ectopic pancreas in the mediastinum is extremely rare. We are reporting on a case of a twenty two year old woman who presented to our clinic with a large cervical mass. The CT scan revealed a cystic lesion in the anterior mediastinum. The patient underwent surgical resection by cervical approach. A Cystic mass with pseudocysts, cysts and complete pancreatic tissue were found in pathology. There were no signs of pancreatitis or malignancy. No recurrence was observed after a follow up of four years. We reviewed the case reports describing this rare condition in the medical literature.We conclude that the possibility of ectopic pancreatic tissue should be included in the differential diagnosis of anterior mediastinal cystic mass, though as a remote possibility. Surgery is probably needed for the diagnosis and treatment. Posterior mediastinal pseudocyst is a different entity associated with acute pancreatitis. In those cases surgery is not recommended. Our third conclusion is that pancreatic tissue should be actively sought, if a structure resembling a pseudocyst is found in an unexpected location.

Virtual slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1849369005957671.

Show MeSH
Related in: MedlinePlus