Large mucinous cystic neoplasm of the pancreas associated with pregnancy

Abstract

Mucinous cystic neoplasms (MCNs) of the pancreas occur mostly in females and are potentially sex hormone-sensitive. However, a MCN occurring during pregnancy is quite rare. A 30-year-old woman in the tenth week of pregnancy was referred to us because of a rapid increase in left hypochondrial distending pain. On ultrasound, the patient had a large intra-abdominal cystic lesion. She was thereafter diagnosed with missed abortion and a computed tomography scan showed that the lesion was a cystic tumor 18 cm in diameter originating from the pancreatic tail. The patient subsequently underwent tumor resection with distal pancreatectomy, sparing the spleen. Histopathological analysis of the specimen revealed a pancreatic MCN with moderate dysplasia. Immunohistochemically, the tumor was positive for both estrogen and progesterone receptors. To our knowledge, this is the first reported case of pancreatic MCN with moderate dysplasia in association with pregnancy. Our case strongly indicates that pancreatic MCN is female-hormone dependent.

Figure 1

Abdominal computed tomography scan showing a huge cyst measuring 18 cm in diameter.

Figure 2

Macroscopic view of the cystic tumor.

Figure 3

Microscopic findings of the cystic tumor. A: Columnar, mucin-producing epithelium with underlying ovarian-type stroma (HE, × 100); B: The epithelium had a focal papillary architecture (HE, × 100); C: Positive staining in the stromal cell nuclei for progesterone receptor (× 400); D: The estrogen receptor of stromal cell nuclei (× 400).