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Resident's Corner |

Cystic Pancreatic Neoplasm in Pregnancy A Case Report and Review of the Literature

James E. S. Wiseman, MD; Maki Yamamoto, MD; Thang D. Nguyen, MD; Jeffrey Bonadio, MD; David K. Imagawa, MD, PhD
Arch Surg. 2008;143(1):84-86. doi:10.1001/archsurg.2007.4.
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Mucinous cystic neoplasms of the pancreas are rare tumors that tend to occur in young women. They are thought to be responsive to sex hormones. We report a case of a 32-year-old pregnant woman with a 7-month history of pain and a left upper quadrant abdominal mass. She arrived at the emergency department with exacerbation of her symptoms during week 15 of gestation. Findings from ultrasonography and magnetic resonance imaging suggested a pancreatic cyst. Percutaneous aspiration of the cyst fluid yielded mucinous fluid with an elevated carcinoembryonic antigen level. The patient underwent a spleen-preserving distal open pancreatectomy. We present herein a brief review of the current literature on mucinous cystic neoplasms during pregnancy. On the basis of our experience and the existing knowledge of this condition, we advocate resection during the second trimester with splenic preservation.

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Figure 2.

Microscopic pathologic features of the resected pancreatic cystic neoplasm. A, Histopathologic examination revealed the mucinous pancreatic cyst lining the epithelium and wall with ovarian-type stroma (hematoxylin-eosin, original magnification ×200). B, Immunohistochemical examination revealed ovarian-type stromal cells expressing the progesterone receptor. Similar results were obtained with antibodies to the estrogen receptor, vimentin, and inhibin (immunohistochemistry stain with an antibody to the progesterone receptor, original magnification ×200).

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Figure 1.

Radiographic imaging in a 32-year-old gravida 5, para 2 woman with a pancreatic cystic lesion. A, Abdominal ultrasound demonstrating a large cystic mass with septations. B, T1-weighted magnetic resonance image of the abdomen showing a large cystic mass in the left upper quadrant with an apparent origin in the tail of the pancreas.

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