Inoue Masashi, Ohmori Ichiro, Karakuchi Nozomi, Takemoto Yuki, Shimomura Manabu, Miyamoto Kazuaki, Ikeda Masahiro, Toyota Kazuhiro, Sadamoto Seiji, Takahashi Tadateru
Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, 513 Jike, Saijo-cho, Higashihiroshima, Hiroshima, 739-0041, Japan.
J Med Case Rep. 2019 Aug 10;13(1):264. doi: 10.1186/s13256-019-2160-2.
Mucinous nonneoplastic cyst of the pancreas is a rare disease defined as a cystic lesion lined with mucinous epithelium, supported by hypocellular stroma and not communicating with the pancreatic ducts. Mucinous nonneoplastic cyst of the pancreas has no malignant potential and does not require surgical resection or surveillance. However, its preoperative differentiation from other cystic lesions of the pancreas is difficult because of several overlapping clinical, radiological, and biochemical features. We report a rare case of large mucinous nonneoplastic cyst of the pancreas in which surgery was required due to infection and the possibility of malignancy.
A 75-year-old Japanese man was found to have a pancreatic cyst in 2006 while undergoing postoperative evaluation for colon cancer. In 2015, the cyst ruptured, and it was treated conservatively. In 2017, he fell down on a road with a fever of 40 °C and was transported emergently to a nearby hospital. Enhanced computed tomography revealed a cystic lesion in the body of the pancreas measuring 119 mm × 100 mm and an adjacent left renal cyst measuring 63 mm in diameter. The wall of the pancreatic cyst was thickened. Magnetic resonance imaging demonstrated a liquid surface in the pancreatic cyst. Pancreatic cyst infection was diagnosed as the source of infection. However, identification of the organism was difficult. Furthermore, due to the increase in the size and wall thickness of the cyst, it was unclear whether the cystic mass was neoplastic with malignant potential. For these reasons, the patient underwent distal pancreatectomy and splenectomy with deroofing of the left renal cyst. Intraoperatively, the pancreatic cyst adhered to the descending colon, and partial resection of the colon was added. Pathologic analysis of the resected cyst demonstrated a simple cyst lined by mucinous epithelium. There was no underlying stromal condensation or epithelial dysplasia, and communication with the native pancreatic ducts was not observed. Based on the operative and histological findings, a final diagnosis of mucinous nonneoplastic cyst of the pancreas with colonic communication was made. The colonic fistula was presumed to be the source of infection.
Mucinous nonneoplastic cyst of the pancreas is generally benign and requires little follow-up, but large cysts may penetrate other organs and cause severe complications.
胰腺黏液性非肿瘤性囊肿是一种罕见疾病，定义为内衬黏液上皮、由细胞稀少的间质支持且不与胰管相通的囊性病变。胰腺黏液性非肿瘤性囊肿无恶变潜能，无需手术切除或监测。然而，由于其在临床、影像学和生化特征上有一些重叠之处，术前将其与胰腺其他囊性病变区分开来较为困难。我们报告一例罕见的胰腺大黏液性非肿瘤性囊肿病例，该病例因感染及存在恶变可能性而需要手术治疗。
一名75岁日本男性在2006年因结肠癌接受术后评估时发现胰腺有一个囊肿。2015年，囊肿破裂，接受了保守治疗。2017年，他在道路上摔倒，体温达40°C，被紧急送往附近医院。增强计算机断层扫描显示胰腺体部有一个119毫米×100毫米的囊性病变，以及一个相邻的直径63毫米的左肾囊肿。胰腺囊肿壁增厚。磁共振成像显示胰腺囊肿内有液平面。胰腺囊肿感染被诊断为感染源。然而，难以确定病原体。此外，由于囊肿大小和壁厚增加，尚不清楚该囊性肿物是否为有恶变潜能的肿瘤性病变。出于这些原因，患者接受了远端胰腺切除术和脾切除术，并对左肾囊肿进行了去顶减压术。术中，胰腺囊肿与降结肠粘连，遂追加了结肠部分切除术。对切除囊肿的病理分析显示为一个内衬黏液上皮的单纯囊肿。无潜在的间质浓缩或上皮发育异常，未观察到与胰腺固有导管相通。根据手术和组织学检查结果，最终诊断为胰腺黏液性非肿瘤性囊肿伴结肠相通。结肠瘘被推测为感染源。
胰腺黏液性非肿瘤性囊肿一般为良性，随访需求少，但大囊肿可能侵犯其他器官并引起严重并发症。
