PMC6297057_01
Imaging findings in CE-CT and MRI. CT showed that the huge cyst had thickened wall and many enhanced nodules. (A) Early phase. Many nodules and the thickened wall were slightly enhanced. (B) Delay phase. They were gradually enhanced. MRI showed that the intensity of intra-cystic fluid was slightly high in T1WI (C) and high in T2WI (D).
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Many nodules and the thickened wall were slightly enhanced in early phase (Fig. 1A) and gradually enhanced in delayed phase (Fig. 1B).
Surgical findings. (A) The cyst did not attach to gastrointestinal tract and originated from pancreatic head. (B) Resected specimen: The cyst was resected completely by partial pancreatectomy. (C) The cystic wall was thickened and elastic soft.
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In surgical findings, this tumor did not attach to gastrointestinal tract and originated from pancreatic head (Fig. 2A). In these reasons, we diagnosed the tumor as hemorrhagic cyst and selected partial pancreatectomy because this tumor was resected completely (Fig. 2B). No tumoral change found in the surface of cystic wall (Fig. 2C).
The pathological findings of non-tumoral tissue (A-C). Non-tumoral epithelium was similar to crypt epithelium of the stomach. The immunohistochemistry was positive for CK7 (D), negative for CK20 (E), and negative for CDX-2 (F). Bar = 100 mum.
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Final pathology demonstrated that the cystic mass had well-formed cyst wall with an inner mucosal lining, submucosal layer, and muscularis propria as gastrointestinal tract (Fig. 3A-C). As the non-tumoral epithelium in small area was similar to crypt epithelium of the stomach and immunohistochemistry of the non-tumoral mucosa was positive for CK7 (Fig. 3D), negative for CK20 (Fig. 3E), and negative for CDX-2 (Fig. 3F), the pathological finding of non-tumoral tissue was the enteric duplication cyst of gastric type.
The pathological findings of tumoral tissue (A-C). Adenocarcinoma with moderate to well differentiation invaded to subserosal layer in broad area of the cystic wall. The immunohistochemistry of the tumoral mucosa was 50% positive for CK7 (D), positive for CK20 (E), and positive for CDX-2 (F). Bar = 100 mum.
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Adenocarcinoma with moderate to well differentiation invaded to subserosal layer over smooth muscle layer in broad area of the cystic wall (Fig. 4A-C). The immunohistochemistry of the tumoral mucosa was 50% positive for CK7 (Fig. 4D), positive for CK20 (Fig. 4E), and positive for CDX-2 (Fig. 4F).