PMC4531962_01
The abdominal CT scan showed 5cm-sized protruding cystic mass in the pancreatic tail with calcification.
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The abdominal computed tomography (CT) scan showed 5cm-sized protruding cystic mass in the pancreatic tail with calcification (Fig. 1).
The abdominal CT revealed that the entire main and branching pancreatic ducts were markedly dilated and pancreatic parenchyme was severely atrophied.
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The entire main pancreatic duct and its branches were markedly dilated and pancreatic parenchyme was severely atrophied (Fig. 2).
Endoscopic retrograde pancreatogram showed poor visualization of the pancreatic duct, but diffuse dilatation of the entire pancreatic duct, with vacuolization in it, was discernible.
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ERP showed diffuse dilatation of the entire pancreatic duct, but opacification of the pancreatic duct was difficult due to the presence of thick mucin (Fig. 3).
The resected portion of the pancreas revealed a cystic mass in the tail. The multilocular cyst was 6x5.5x4.5cm in size and connected with the branch duct. The entire main and branch ducts were diffusely dilated. The lumen of ducts were filled with mucin and their walls showed diffuse intraluminal papillary protrusion.
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The lumen of the pancreatic duct and cyst was filled with mucin and their walls showed diffuse intraluminal papillary protrusion (Fig. 4).
Microscopically, the ductal epithelium and cyst wall was replaced by papillary or villous proliferating tall columnar cells of mucinous type(A: H&E, x40). The degree of proliferation and cellular atypism varied in areas. The large portion of the duct and cyst showed papillary hyperplasia(B: H&E, x100) or adenomatous(C: H&E, x100) change of epithelium with atypia. In some areas, marked nuclear atypism and architectural complexity with cribriform pattern and irregular budding was identified and this finding was regarded as carcinomatous change(D: H&E, x200).
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The large proportion of duct and cyst showed papillary hyperplasia or adenomatous change of the epithelium and carcinomatous change in some areas (Fig. 5).