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Article 19, 4/2016

CASE REPORT

A Case of Serous Cystadenoma Communicating with a Stenotic Santorini’s Duct and a Dilated Main Pancreatic Duct

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Hiroyuki Matsubayashi1, Yurika Oka2, Takaaki Ito2, Katsuhiko Uesaka2, Keiko Sasaki3, Hiroyuki Ono1

Division of
1) Endoscopy,
2) Hepato-Biliary-Pancreatic Surgery, and
3) Pathology, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.254.tsu

ABSTRACT
A 59-year-old woman was referred for investigation of a pancreatic cystic lesion. Computed tomography revealed a well-demarcated, multilocular cyst, approximately 4 cm in size, at the pancreas head. Endoscopic ultrasonography demonstrated honeycomb-like components at the cyst margin. The cyst was associated with a widely-dilated upstream main pancreatic duct (MPD). Endoscopic retrograde pancreatography demonstrated a communication between the stenotic Santorini‘s duct and the cyst. Aspiration cytology from the cyst demonstrated clusters of mucinous epithelial neoplasm cells. Branch-type intraductal papillary mucinous neoplasm, possibly invading to the MPD, was suspected and pancreatoduodenectomy was performed. Surprisingly, pathology of the resected pancreas showed mixed-type serous cystadenoma.

Key words: pancreas – serous cystadenoma – communication – pancreatic duct – diagnosis.

Abbreviations: CA19-9: cancer antigen 19-9; CEA: carcinoembryonic antigen; ERC: endoscopic retrograde cholangiography; ENPD: endoscopic naso-pancreatic drainage ; ERP: endoscopic retrograde pancreatography; EUS: endoscopic ultrasonography; NET: neuroendocrine tumor; FNA: fine needle aspiration; IPMN: intraductal papillary mucinous neoplasm; MRCP: magnetic resonance cholangiopancreatography; MPD: main pancreatic duct; SCA: serous cystic neoplasms.