Mucinous Cystic Neoplasm of the Pancreas Presenting with Acute Pancreatitis: Report of a Case

以急性胰臟炎表現之胰臟黏液性囊性腫瘤：一病例報告

王嗣仁(Szu-Jen Wang) ； 孫啟書(Chi-Shu Sun) ； 許銘仁(Ming-Jen Sheu) ； 林勤益(Ching-Yih Lin) ； 田宇峰(Yu-Feng Tian) ； 林靖南(Ching-Nan Lin)

《臺灣消化醫學雜誌》 28卷4期 (2011/12) Pp. 371-378

https://doi.org/10.6557/GJT.201112_28(4).0006

摘要

胰臟囊性腫瘤極少以急性胰臟炎為單一之表現症狀。一位60歲女性，過去並無膽結石或酗酒的病史，入院的主要診斷是反覆性急性胰臟炎及假性囊腫，因為胰臟炎的病史、胰臟的假性囊腫且症狀經過了六個月並無改善，所以建議病患接受手術引流；但手術時並無發現該病兆與其周圍組織有發炎過或沾黏的痕跡，此一現象與假性囊腫不符，術中用空針抽吸出黏液性物質，故高度懷疑是黏液性囊性腫瘤，所以將胰臟尾部及該囊腫病灶切除，最後病理診斷是良性的黏液性囊性腫瘤。術前要鑑別診斷是發炎性或腫瘤性囊腫有相當的困難度，尤其是當病患以急性胰臟炎為首要表現時，所以當急性胰臟炎發生在無膽結石或非酗酒的女性病患時，腫瘤性囊腫就應該列入鑑別診斷中。

關鍵字

急性胰臟炎 ； 假性囊腫 ； 黏液性囊性腫瘤

並列摘要

Acute pancreatitis is only rarely the first presentation of a cystic neoplasm of the pancreas, especially mucinous cystic neoplasm. However, a 60-year-old woman was admitted to our hospital with a history of recurrent pancreatitis and a pseudocyst diagnosed six months ago. Abdominal computed tomography (CT) revealed an encapsulated cystic leson 11 cm x 9.7 cm in size in the pancreatic tail. A communication between the cystic lesion and the main pancreatic duct (MPD) was suspected by CT. Endoscopic ultrasonography demonstrated no mural nodule or septum in the cystic lesion and still suspected the MPD connected with this cystic lesion through an infundibuliform structure. Pancreatic pseudocyst was favored due to the history of pancreatitis, no mural nodule, no septum and a communication with the MPD. Surgical intervention for the pseudocyst was suggested for symptomatic pseudocyst without regression in the past six months. An endoscopic retrograde pancreatography before the operation showed a tortous dilated MPD with interruption and no contrast medium leakage into the cystic lesion. During the operation, no inflammation adhesion was found between the huge cystic lesion and the surrounding tissue. Intraoperative aspiration of the cystic fluid revealed mucin and a mucinous cystic neoplasm was diagnosed. The final pathologic diagnosis was benign mucinous cystic neoplasm (mucinous cystadenoma).Pre-operative differential diagnosis between inflammatory and neoplastic cysts is difficult, especially when the patient's first presentation is an episode of acute pancreatitis. A neoplastic cyst should be considered when acute pancreatitis attacks occur in non-alcoholic women, who do not have gallstone disease.

並列關鍵字

acute pancreatitis ； pseudocyst ； mucinous cystic neoplasm