Spontaneous Rupture of Pancreatic Mucinous Cystadenocarcinoma: A Case Report and Review of Literature / 대한췌담도학회지

The pancreatic cystic lesions are known to be incidentally found up to 10-15% of patients undergoing cross-sectional imaging. And the prevalence of mucinous cystic neoplasm which has malignant potential is known to be up to 25% of all pancreatic cystic neoplasm in South Korea. The symptoms included abdominal pain, palpable mass, weight loss, loss of appetite, jaundice, asymptomatic and etc. However, spontaneous rupture of pancreatic mucinous cystadenocarcinoma (MCAC) is an extremely rare complication. Here we report a case of spontaneous rupture of pancreatic MCAC in a 72-year-old male with review of the literature. To the best of our knowledge, this is the first ruptured case of pancreatic MCAC in male patient.

A Patient with Mixed Squamous Cell and Papillary Thyroid Carcinoma

Mixed squamous cell carcinoma and papillary carcinoma in the thyroid gland is a very rare malignant tumor. Primary squamous cell carcinoma of the thyroid may develop from squamous metaplasia of the follicular epithelium in a variety of pathologic conditions, such as other differentiated carcinomas of the thyroid. A 70-year-old man presented with a palpable mass on the right side of the thyroid gland. The patient underwent a right lobectomy without neck lymph node dissection. Histopathological findings revealed primary squamous carcinoma mixed papillary thyroid carcinoma. He underwent a completion thyroidectomy and radioactive iodine therapy. Adjuvant radiotherapy and chemotherapy were not performed.

Cervical Bronchogenic Cyst

Head and neck surgeons see many congenital cysts of the neck. Most of these cysts are thyroglossal duct cysts and branchial cleft cysts. Bronchogenic cysts are rare congenital malformations of the ventral foregut development. They are usually located in the mediastinum and intrapulmonary regions. Cervical bronchogenic cysts are unusual. Only 70 cases of bronchogenic cysts in the head and neck regions have been reported on and the majority of cases have been found in the pediatric population. We describe here a 61-year-old female who presented a palpable left neck mass. The preoperative diagnostic studies included chest X-ray and sonography-guided fine needle aspiration. The neck sonography showed the mass, but it could not rule out a pathologic lymph node. Aspirated material contained no cellular content. The mass was excised. The neck mass of the patient was diagnosed as a bronchogenic cyst. We suggest that the clinical observation of a lateral neck mass in an adult includes the possibility of a bronchogenic cyst in the differential diagnosis.

Hepatoid Adenocarcinoma of the Stomach Presenting as a Huge Abdominal Mass

Hepatoid adenocarcinoma is a rare variant of adenocarcinoma of the stomach. The tumor has been found to be an alpha-fetoprotein (AFP) producing carcinoma arising in extrahepatic organs, and it mimics hepatocellular carcinoma in terms of morphology and function. Vascular invasion, usually prominent, is often complicated by extensive liver metastases, and vascular permeation, especially in the veins, has been described as a characteristic finding of this tumor. A patient with hepatoid adenocarcinoma of the stomach with a huge mass is described. Gastrofiberscopy revealed an elevated lesion with a central depression on the greater curvature of the antrum and with extrinsic compression on the lesser curvature and the duodenum. Computed tomography revealed a large lobulated mass in the lesser curvature of the stomach, attached from the liver, gall bladder and porta hepatitis to the pancreas. The AFP serum level was markedly elevated. After a diagnosis was made of AFP-producing stomach carcinoma with huge lymph node metastasis, subtotal gastectomy with wedge resection of the liver, and cholecystectomy including the huge mass ware performed. Microscopically, the tumor and intraabdominal huge mass showed mainly hepatoid differentiation. The tumor showed immunohistochemical positivity for AFP and huge lesser omental metastasis with adhesion to the liver and extensive venous invasion. Lymph node metastasis was not found. According to these histopathological findings, the tumor was diagnosed as hepatoid adenocarcinoma of the stomach with venous invasion. We report this rare variant of adenocarcinoma of the stomach, which mimics hepatocellular carcinoma in its propensity for venous permeation.

Mucin-Producing Intrahepatic Cholangiocelluar Carcinoma Presenting as a Focal Dilatation of the Intrahepatic Bile Duct

A case of a mucin-producing intrahepatic cholangiocellular carcinoma (MPCC) is reported. A 58-year old female presented with epigastric discomfort of several years duration. The physical examination and laboratory findings were normal. Abdominal ultrasonography (US) and computed tomography (CT) showed a focal dilatation of the right posterior intrahepatic bile duct. There was no abnormal mass in the liver parenchyma. Endoscopic retrograde cholangiopancreaticography (ERCP) showed a filling defect in the right posterior hepatic duct. There was no anatomical abnormality and abnormal staining on the heaptic angiography. At the operation, the right posterior hepatic duct was filled with mucin. The patient had a right posterior segmentectomy. Histologically, a 2.5 X 0.6 X 0.6 cm sized mucin-producing intrahepatic cholangiocellular carcinoma was found in segment 6 of the liver. The postoperative recovery was good, and the patient has had a good social life for the last 3 years, with no evidence of tumor recurrence. In patients with a focal dilatation of the intrahepatic bile duct on CT or US with no underlying cause, an intrahepatic malignancy has to be suspected.