Iusco D R, Navarra G, Bonomi S, Grassi A, Vicari S, Virzì S
Bentivoglio Hospital, Bologna, Italy.
G Chir. 2012 May;33(5):163-7.
Cystic tumour of the pancreas are infrequent and malignancy of the pancreas during pregnancy is extremely rare. Mucinous cystoadenomas is the most frequent cystic pancreatic neoplasm and it is seen mainly in women suggesting a sex hormone influence. Its presentation during pregnancy is extremely rare and entails difficulties in diagnosis and therapy.
A 28 year old woman was referred to our service for abdominal mass. She had given birth to her second child two weeks previously. Ultrasound and CT scan showed a large cystic lesion, with sepitation and inner solid growth portions, involved mainly the left sovramesocolic space. An ultrasound-guided aspiration of the cystic fluid showed high level of CEA and CA. 19-9. The patient underwent laparotomic body-tail pancreatectomy and splenectomy. The histological examination showed mucinous cystoadenoma with associated invasive ductal carcinoma, with ovarian-like stroma and a well delimited fibrous capsule. Hystochemical study revealed a strong positivity for progesterone receptors.
To our knowledge this is the eighth case of mucinous cystoadenoma reported in English literature and the forth with an invasive adenocarcinoma associated. This pathological entity should always be kept in mind in case of patient with an hepigastric mass during or soon after pregnancy. Aggressive approach is mandatory.
胰腺囊性肿瘤较为少见，孕期发生胰腺恶性肿瘤极为罕见。黏液性囊腺瘤是最常见的胰腺囊性肿瘤，主要见于女性，提示有性激素影响。其在孕期的表现极为罕见，诊断和治疗均有困难。
一名28岁女性因腹部肿块转诊至我院。她两周前刚生下第二个孩子。超声和CT扫描显示一个大的囊性病变，有分隔和内部实性生长部分，主要累及左结肠系膜上间隙。超声引导下对囊液进行抽吸，结果显示癌胚抗原（CEA）和糖类抗原19-9（CA 19-9）水平升高。患者接受了剖腹体尾部胰腺切除术和脾切除术。组织学检查显示为黏液性囊腺瘤合并浸润性导管癌，伴有卵巢样间质和界限清楚的纤维包膜。免疫组织化学研究显示孕激素受体呈强阳性。
据我们所知，这是英文文献中报道的第八例黏液性囊腺瘤病例，也是第四例合并浸润性腺癌的病例。对于孕期或产后不久出现上腹部肿块的患者，应始终牢记这一病理实体。必须采取积极的治疗方法。
