Berindoague Rene, Targarona Eduard, Savelli Alfredo, Pernas Juan, Lloreta Josep
Service of General Surgery, Hospital Sant Pau of Barcelona, Autonomous University of Barcelona, Calle Padre Claret 167, 08025 Barcelona, Spain.
Langenbecks Arch Surg. 2007 Jul;392(4):493-6. doi: 10.1007/s00423-007-0193-2. Epub 2007 May 26.
Cystic tumors of the pancreas are uncommon. They account for 10-15% of all pancreatic cystic masses and only 1% of pancreatic malignancies. Mucinous cystadenocarcinoma is the most frequent pancreatic cystadenocarcinoma and it is mainly seen in women, suggesting a sex hormone influence. Its presentation during pregnancy is infrequent and entails difficult diagnostic and therapeutic decisions. We report the case of a 31-year-old woman who presented a pancreatic cystadenocarcinoma 2 months after delivery.
A 31-year-old woman was referred to our service because of abdominal pain and mass. She had given birth to her first child 2 months previous. Abdominal ultrasound demonstrated a poorly circumscribed cystic mass in the left upper abdominal quadrant, and the computed tomography scan showed a multilocular cystic lesion located in the body of pancreas. There was no seric alteration of specific pancreatic enzymes or tumor markers.
Laparoscopic examination showed a large cystic tumor (12 x 11 x 5.5 cm) in the pancreas involving the body and the tail. It extended to the spleen and was highly vascularized, precluding a minimal invasive resection. An open body-tail pancreatectomy and splenectomy was performed. The resection margins were free of tumor, and the histological study showed a mucinous pancreatic cystadenocarcinoma with mucin-producing columnar epithelium and associated papillae patterns, reminiscent of ovarian stroma. Immunohistochemical studies were negative for hormonal receptors. The patient had no post-surgical complications and was discharged home in 4 days.
Cystic tumors of the pancreas are infrequent, and cancer of the pancreas during pregnancy is extremely rare. Insidious symptoms and bodily changes due to pregnancy may mask diagnosis. Aggressive surgery is currently the only chance of cure.
胰腺囊性肿瘤并不常见。它们占所有胰腺囊性肿块的10 - 15%，仅占胰腺恶性肿瘤的1%。黏液性囊腺癌是最常见的胰腺囊腺癌，主要见于女性，提示有性激素影响。其在妊娠期的表现罕见，诊断和治疗决策困难。我们报告一例31岁女性，产后2个月出现胰腺囊腺癌。
一名31岁女性因腹痛和腹部肿块转诊至我院。她2个月前刚生下第一个孩子。腹部超声显示左上腹象限有一个边界不清的囊性肿块，计算机断层扫描显示胰腺体部有一个多房囊性病变。特异性胰腺酶或肿瘤标志物无血清学改变。
腹腔镜检查显示胰腺有一个大的囊性肿瘤（12×11×5.5 cm），累及体部和尾部。它延伸至脾脏，血管丰富，无法进行微创切除。遂行开放性胰体尾切除术和脾切除术。切缘无肿瘤，组织学研究显示为黏液性胰腺囊腺癌，有产生黏液的柱状上皮和相关乳头结构，类似卵巢间质。免疫组化研究显示激素受体阴性。患者术后无并发症，4天后出院。
胰腺囊性肿瘤少见，妊娠期胰腺癌极为罕见。妊娠引起的隐匿症状和身体变化可能掩盖诊断。积极手术是目前唯一的治愈机会。
