Kuba H, Yamaguchi K, Shimizu S, Yokohata K, Sugitani A, Chijiiwa K, Tanaka M
First Department of Surgery, Kyushu University Faculty of Medicine, Fukuoka, Japan.
J Gastroenterol. 1998 Oct;33(5):766-9. doi: 10.1007/s005350050171.
Pseudocyst of the pancreas is sometimes difficult to distinguish from mucinous cystic neoplasm of the pancreas. A 37-year-old asymptomatic Japanese man was diagnosed with hypertension. He had a 20-years history of habitual drinking of alcohol, but no history of pancreatitis or abdominal trauma. During examinations to ascertain the cause of hypertension, ultrasonography and computed tomography incidentally demonstrated a huge cyst in the head of the pancreas. Laboratory data were within normal limits, including serum levels of amylase, carcinoembryonic antigen, and carbohydrate antigen 19-9. Imaging studies showed a huge unilocular cyst, measuring 7 cm, in the head-to-body of the pancreas, and two small unilocular cysts, measuring 1.4 and 1.5 cm, in the tail and head of the pancreas, respectively. A mural nodule was suspected in the largest cyst. Endoscopic retrograde cholangiopancreatography demonstrated communication of the main pancreatic duct with the two small cysts in the head and tail of the pancreas but not with the huge cyst. There were no ductal changes suggesting chronic pancreatitis. Laparotomy was performed under the tentative diagnosis of potentially malignant mucinous cystic neoplasms of the pancreas. However, inflammatory adhesion was dense around the pancreas and the mural nodule suspected preoperatively was found to be sludge aggregates in a pseudocyst. The diagnosis of an intraoperative frozen section of the cyst wall was pseudocyst of the pancreas. Cystojejunostomy was performed. We report this case because the preoperative diagnosis was mucinous cystic neoplasm of the pancreas, but the diagnosis changed with careful intraoperative examinations, to pseudocyst of the pancreas. We discuss the differential diagnosis of the two conditions.
胰腺假性囊肿有时难以与胰腺黏液性囊性肿瘤相区分。一名37岁无症状的日本男性被诊断为高血压。他有20年的酗酒史，但无胰腺炎或腹部外伤史。在查明高血压病因的检查过程中，超声检查和计算机断层扫描偶然发现胰腺头部有一个巨大囊肿。实验室检查数据均在正常范围内，包括血清淀粉酶、癌胚抗原和糖类抗原19-9水平。影像学研究显示，在胰腺头体部有一个7厘米的巨大单房囊肿，在胰腺尾部和头部分别有两个1.4厘米和1.5厘米的小单房囊肿。最大的囊肿内疑似有一个壁结节。内镜逆行胰胆管造影显示主胰管与胰腺头部和尾部的两个小囊肿相通，但与巨大囊肿不相通。没有提示慢性胰腺炎的导管改变。在初步诊断为潜在恶性的胰腺黏液性囊性肿瘤的情况下进行了剖腹手术。然而，胰腺周围的炎性粘连很致密，术前怀疑的壁结节在术中发现是假性囊肿内的淤泥样聚集物。囊肿壁的术中冰冻切片诊断为胰腺假性囊肿。进行了囊肿空肠吻合术。我们报告这个病例是因为术前诊断为胰腺黏液性囊性肿瘤，但经过仔细的术中检查后诊断变为胰腺假性囊肿。我们讨论了这两种情况的鉴别诊断。
