Department of Mother and Child, Emergency County Hospital Craiova, Craiova, Romania.
Gynecol Obstet Invest. 2013;75(2):132-8. doi: 10.1159/000346176. Epub 2013 Jan 18.
Pancreatic mucinous cystic neoplasms are uncommon and their occurrence in pregnancy is extremely rare. The authors report the unique case of a newborn weighing 3,620 g, delivered vaginally with no complications by a patient with a large 'silent' pancreatic mucinous cystic neoplasms, and analyze the very few other reports. With no available protocol, this case highlights an interesting dilemma on the management of pregnancy and delivery as well on the timing of pancreatic surgery. Despite its limitations, MRI remains the most accurate investigation either for differentiating the mucinous from nonmucinous cysts or for evaluating the malignancy, but echography is also very useful. Without symptoms, all low-grade malignant potential tumors, independent of the moment of their diagnosis during pregnancy, should be resected 2-3 months after delivery and we believe that the best option is a term vaginal birth, even in the presence of a large cyst and large fetus. On the contrary, all high-grade malignant potential tumors, discovered in the first two trimesters of pregnancy should be resected during the second trimester, and followed by a vaginal delivery at term. If high-grade malignant potential tumor is diagnosed in the third trimester, an early vaginal delivery followed by surgery is recommended. Finally, the patient's preference is crucial.
胰腺黏液性囊性肿瘤并不常见，其在妊娠期间的发生极其罕见。作者报告了一个独特的病例，一位患者患有巨大的“无症状”胰腺黏液性囊性肿瘤，经阴道分娩出一名 3620 克重的新生儿，无任何并发症，并对其他少数几例报告进行了分析。由于没有可用的方案，该病例突出了妊娠和分娩管理以及胰腺手术时机方面的一个有趣的困境。尽管存在局限性，但 MRI 仍然是区分黏液性和非黏液性囊肿或评估恶性肿瘤的最准确的检查方法，但超声检查也非常有用。对于所有低级别恶性潜能肿瘤，无论在妊娠期间何时诊断，无症状者均应在分娩后 2-3 个月切除，我们认为最好的选择是足月阴道分娩，即使存在大囊肿和大胎儿。相反，所有高级别恶性潜能肿瘤，如在妊娠前 2 个 trimester 中发现，应在孕中期切除，然后足月行阴道分娩。如果在孕晚期诊断出高级别恶性潜能肿瘤，则建议早期行阴道分娩，然后进行手术。最后，患者的偏好至关重要。
