Avoiding the diagnostic pitfalls of a pancreatic cystic lesion.

SUMMARY: Cystic pancreatic lesions present a diagnostic challenge. Accurate characterisation of an isolated cystic pancreatic lesion is therefore vital as this dictates the management strategy which may vary from radical resection to simple observation. This report describes how a detailed preoperative assessment led to the correct diagnosis of an isolated pancreatic lesion and appropriate safe and curative surgical management.

Isolated pancreatic cysticercal cyst presenting as a diagnostic challenge: diagnosis and treatment review.

Human cysticercosis most commonly affects the subcutaneous tissues, skeletal muscles, lungs, brain, eyes, liver and, rarely, the heart, thyroid and pancreas. Owing to vague clinical presentation and unfamiliarity of clinicians with this entity, it is difficult to diagnosis when seen as an isolated cyst. We present a case of a 16-year-old boy who presented with an upper abdominal lump and jaundice. Ultrasonography (USG) and MRI of the abdomen were carried out, which revealed a cystic mass (8.5 × 7 × 7 cm) in the pancreas. No evidence of solid component or papillary projections was noted within the lesion. Tumour markers carcinoembryonic antigen (CEA) and cancer antigen (CA 19-9) were normal. Fine needle aspiration cytology was performed, which revealed the presence of cysticercus larvae, along with a foreign body giant cell reaction. The patient was treated with therapeutic aspiration and antihelminthic therapy. Since then, he has been symptom free and under regular follow-up for the last 1 year. A diagnosis of cysticercal cyst at atypical sites is very rare and depends mainly on histopathological examination, which, along with USG and MRI, can give an accurate analysis. These cysts can be very well treated non-surgically with antihelminthics and aspiration.

Pancreatic hydatid cyst masquerading as a choledochal cyst.

A 6-year-old boy presented with repeated attacks of fever, abdominal pain, and obstructive jaundice. Clinical examination and preoperative imaging suggested the diagnosis of a type I choledochal cyst. During surgery, a hydatid cyst was found occupying the head of pancreas, causing obstruction of the common bile duct. The authors emphasize that in endemic areas, hydatid cyst should be included in the list of conditions in the differential diagnoses of obstructive jaundice and cystic lesions located around the bilio-pancreatic junction in children.

Clinical considerations of primary hydatid disease of the pancreas.

BACKGROUND: The pancreas is a rare primary location of hydatid disease. The purpose of our study is to gain more insight into this entity and to focus on the management and the diagnostic approach to the disease. METHODS: The medical records of 5 patients with hydatid cysts of the pancreas were reviewed. RESULTS: Four of the cysts were primary, while in 1 case a coexisting cyst was found in the liver. The body and tail of the pancreas were the most common locations. Clinical presentation varied according to the anatomic location of the cyst. Abdominal pain, discomfort and vomiting were the main clinical symptoms. One patient presented with obstructive jaundice, while another patient manifested a mild episode of anaphylactic shock. The indirect hemagglutination test was positive in 3 of 4 cases. A computed tomography scan successfully imaged all cysts and calcification of the cystic wall was found in 3 of 4 cases. All patients underwent surgical therapy. Hydatid cysts in the tail of the pancreas were successfully treated with distal pancreatectomy, while cysts in the body and head of pancreas were treated with proper evacuation, pericystectomy and omentoplasty. The postoperative course was uneventful in all patients except 1 who presented a pancreatic fistula and was re-operated. The mean length of hospitalization after surgery was 11-12 (range 10-13) days, except for the patient who needed to be re-operated. No evidence of cyst recurrence was observed during the follow-up period. CONCLUSIONS: Hydatid cystic masses of the upper abdomen might also originate from the pancreas especially in endemic countries. Surgical excision of the entire cystic lesion remains the optimal treatment, offering hope for a complete cure.

Primary pancreatic hydatid disease in a child: case report and review of the literature.

A 9-year-old boy was admitted with acute abdomen, and a cystic mass in the pancreas was coincidentally detected by ultrasonography. Definitive diagnosis of hydatid disease of the pancreas could be made only at operation, and surgical therapy was effective.

Pancreatic hydatid cyst.

A patient with primary hydatid cyst involving the tail of the pancreas and treated successfully by distal pancreatectomy is reported. Additionally, we performed splenectomy because the spleen was lifted on to the cyst, and cholecystectomy for cholelithiasis.

Hydatid cyst in the head of the pancreas with obstructive jaundice.

We report a rare case of obstructive jaundice caused by an intrapancreatic hydatid cyst in a 17-year-old black girl. Ultrasonography and computed tomography demonstrated the obstructing cyst in the head of the pancreas. Cyst aspiration produced clear fluid with a low amylase content and no hydatid hooklets or protoscolices. Pancreaticoduodenectomy was performed for a presumed cystic neoplasm of the pancreas, but histology showed the true diagnosis. Pancreatic hydatidosis should be considered in the differential diagnosis of obstructing pancreatic cysts in the appropriate epidemiological setting.

Surgical treatment of hydatid cysts of the pancreas.

This series consists of seven patients with hydatid cysts of the pancreas; five females and two males, with an average age of 31 years. In a follow-up extending up to 33 years, about a 50% rate of correct preoperative diagnosis was recorded. The most sensitive and effective diagnostic modalities such as latex agglutination, ultrasonic, radionuclide, computerized tomographic and magnetic resonance imaging techniques were not available till the late seventies and therefore were only used during diagnosis of the latter 3 cases. Four patients had cysts located in the head of the pancreas. Three cysts were situated in the body and tail. Two distal pancreatectomies, two cystectomies and three marsupialization and external drainage procedures were performed for the surgical management of these cases. Two of the marsupialized and externally drained patients had fistulas which eventually dried up within a month leading to a total morbidity of 29% and a mortality rate of nil.