Department of Obstetrics and Gynecology, Nagoya University School of Medicine, Nagoya, Japan.
Taiwan J Obstet Gynecol. 2012 Dec;51(4):635-8. doi: 10.1016/j.tjog.2012.09.022.
Mucinous cystic neoplasm (MCN) of the pancreas occurs mainly in women aged 40-60 years, so it is extremely rare in pregnant woman.
A 28-year-old woman in the ninth week of pregnancy was referred to our hospital due to a tumor of the abdominal cavity. Abdominal ultrasound demonstrated a huge multicystic lesion in the left upper abdomen. There are mural nodules and hypertrophic septa partially with the presence of blood flow inside the tumor. Endoscopic ultrasonography was performed and a diagnosis of possible pancreatic MCN was made. At the second trimester, distal pancreatectomy with splenectomy was performed. Histopathological analysis of the specimen revealed a pancreatic MCN with severe dysplasia. Immunohistochemically, the tumor was positive for both progesterone and estrogen receptors in the stromal cell nuclei; moreover, MIB-1 stained positive in 10-20% of the nuclei in the epithelium with severe dysplasia.
MCN carries malignant potential, therefore, early detection and complete surgery is recommended. MCN in pregnancy is rare and the abdomen is distended during pregnancy, so clinicians can easily miss the presence of the tumor. We should recognize the presence of MCN in pregnant woman. We speculate that the presence of blood flow within the tumor and MIB-1-positive cells can be a predictor for premalignant or malignant MCN.
胰腺黏液性囊性肿瘤（MCN）主要发生于 40-60 岁的女性，因此在孕妇中极其罕见。
一名 28 岁的孕妇在妊娠第 9 周时因腹腔肿瘤被转至我院。腹部超声显示左上腹部有一个巨大的多囊性病变。肿瘤部分存在壁结节和肥厚的隔膜，内部有血流。进行了内镜超声检查，诊断为可能的胰腺 MCN。在妊娠中期，进行了胰体尾切除术加脾切除术。标本的组织病理学分析显示为具有重度异型增生的胰腺 MCN。免疫组化显示，肿瘤间质细胞核中孕激素和雌激素受体均呈阳性；此外，上皮细胞中具有重度异型增生的细胞核中 MIB-1 阳性率为 10-20%。
MCN 具有恶性潜能，因此建议早期发现并进行完整的手术切除。妊娠合并 MCN 罕见，且妊娠期间腹部膨隆，因此临床医生容易漏诊肿瘤。我们应该认识到孕妇中存在 MCN。我们推测肿瘤内存在血流和 MIB-1 阳性细胞可能是预示 MCN 为癌前或恶性的指标。
