Dhali Arkadeep, Ray Sukanta, Khamrui Sujan, Dhali Gopal Krishna
Department of GI Surgery, IPGME&R, School of Digestive & Liver Diseases, Kolkata, India.
Department of GI Surgery, IPGME&R, School of Digestive & Liver Diseases, Kolkata, India.
Int J Surg Case Rep. 2021 Aug;85:106240. doi: 10.1016/j.ijscr.2021.106240. Epub 2021 Jul 26.
Pancreatic mucinous cysadenocarcinoma is a rare neoplasm of pancreas which rarely presents as upper gastrointestinal bleed.
A 45-year-old woman presented with history of repeated episodes of melena and abdominal pain. Upper gastrointestinal endoscopy revealed a growth in the body of the stomach likely to be a gastrointestinal stromal tumor (GIST). Endoscopic biopsy was inconclusive for GIST or malignancy. Computed tomography scan of the abdomen showed a well-defined multiloculated cystic lesion (11.8 × 11.1 × 6.4 cm) in the body and tail of the pancreas with involvement of the stomach. Preoperative diagnosis was a cystic neoplasm of the pancreas with tumor ingrowth into the stomach. The patient underwent enbloc resection of the stomach with distal pancreatectomy and splenectomy. Histopathological examination revealed low grade mucinous cystadenocarcinoma of the pancreas.
Upper gastrointestinal bleed as a manifestation of cystic neoplasms of pancreas are rarely reported. Although some cases of hemoperitoneum were reported due to rupture of tumor; luminal gastrointestinal bleed is even rarer. It may be due to involvement of porto-mesenteric axis with portal hypertension, direct invasion of the gastric wall with ulceration of the gastric mucosa, communication between the tumor and the main pancreatic duct, and from the infiltrating tumor.
Our case highlights the fact that mucinous cystadenocarcinoma of pancreas rarely can present with upper gastrointestinal hemorrhage, Moreover, if it is large enough to compress or invade the stomach, endoscopy may misdiagnose it as GIST.
胰腺黏液性囊腺癌是一种罕见的胰腺肿瘤，很少表现为上消化道出血。
一名45岁女性有反复黑便和腹痛病史。上消化道内镜检查发现胃体部有一肿物，可能为胃肠道间质瘤（GIST）。内镜活检对于GIST或恶性肿瘤无法确诊。腹部计算机断层扫描显示胰腺体尾部有一个边界清晰的多房囊性病变（11.8×11.1×6.4cm），累及胃部。术前诊断为胰腺囊性肿瘤伴肿瘤长入胃内。患者接受了胃整块切除、远端胰腺切除和脾切除术。组织病理学检查显示为胰腺低级别黏液性囊腺癌。
胰腺囊性肿瘤表现为上消化道出血的情况鲜有报道。虽然有一些因肿瘤破裂导致腹腔积血的病例报道；但腔内胃肠道出血更为罕见。这可能是由于门肠系膜轴受累伴门静脉高压、肿瘤直接侵犯胃壁导致胃黏膜溃疡、肿瘤与主胰管相通以及肿瘤浸润所致。
我们的病例突出了这样一个事实，即胰腺黏液性囊腺癌很少会表现为上消化道出血，此外，如果肿瘤足够大以至于压迫或侵犯胃，内镜检查可能会将其误诊为GIST。
