PMC6319693_01
Computed tomography of the abdomen (axial view) displaying a calcified, cystic mass in the tail of the pancreas with an area of central scarring (yellow arrow) and evidence of peripancreatic inflammation and edema (red arrow heads). The splenic artery can be seen coursing through the pancreas in a tortuous manner (red arrows).
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A review of her abdominal imaging revealed a 3 cm complex cystic mass in the pancreatic tail, with thickened septa, and an associated solid nodule that appeared calcified, and was associated with central scarring (Fig. 1). Peripancreatic edema on CT (Fig. 1) was interpreted as evidence of acute pancreatitis, further confounding the clinical picture.
(a) T2 weighted single shot fast spin echo axial MRI displaying a mass in the pancreatic tail (yellow arrow) (b) Axial LAVA 5 min delay MRI displaying presence of a cystic mass in the pancreatic tail and peripheral postenhancement (yellow arrow). MRI, magnetic resonance imaging.
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Peripheral enhancement was observed on an MRI (Fig. 2a, b), raising the possibility of a mucinous cystic neoplasm as well.
Frozen section pathology sections displaying (a) irregular ductal structures (solid arrows), (b) diffuse desmoplastic and sclerotic stroma (solid arrow), and atypical, infiltrating epithelium (dashed arrows), (c) compressed and incomplete ductal lumen, evident by discontinuity in ductal epithelium (solid arrow). (All hematoxilin-eosin stained).
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Microscopic examination revealed desmoplastic stroma, which distorted the glands, and atypical epithelium (Fig. 3a-c) infiltrating toward the edge of the resection margin.
Permanent pathology specimen displaying simple cystic epithelium (solid black arrows) of a calcified microcystic serous cystadenoma. Apparent distortion in simple cystic morphology (red arrows) is caused by mass compression and not dysplasia. Background of chronic pancreatitis made evident by atrophied acinar tissue (dashed arrow, upper right corner).
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There was no evidence of invasive adenocarcinoma (Fig. 4).