PMC6806458_01
MRCP showing innumerable saccular dilations (A) associated with dilation of the main pancreatic duct and a 1.2 cm stone in the pancreatic head (B).
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She had also undergone an MRI/MRCP at the outside hospital that revealed multiple cystic loculations of the pancreas that appeared to be possibly in communication with the main pancreatic duct (Fig. 1).
CT abdomen showing multiple cystic lesions within the pancreas. The largest cystic lesion in the mid-body pancreas measures 5.1 cm in maximal diameter and appears to communicate with the main pancreatic duct (A). Also seen is a cluster of smaller cystic lesions within the pancreas head and tail. Downstream, again seen is a large 1.7 cm pancreatic duct calculus (B). The head and uncinate process of pancreas demonstrate multiple scattered punctate calcifications.
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Antigen 19-9 (CA 19-9) was <1. A three-phase pancreas protocol CT scan was performed at our institution that showed dilation of the main pancreatic duct with innumerable saccular cystic dilations, thought to be likely dilated side branches arising from the pancreatic duct (Fig. 2).
Cytologic, macroscopic, and histologic analysis. Fine needle biopsy shows rare clusters of mucinous epithelium (A). The pancreas is opened to reveal multiple cystic structures (ranging from 0.5 to 7.7 cm) containing a brown-tan, thin liquid located throughout the pancreatic head, neck, and tail. The cysts are surrounded by areas of fibrosis and contain multiple yellow-tan to white-tan stones. The cysts involve ~80% of the pancreatic parenchyma and obstruct the pancreatic duct at the pancreatic neck (B). The entire cystic lining was submitted for histologic exam and reviewed. Sections show cysts lined by flat low-grade foveolar-type and focal pancreatico-biliary type epithelium with focal ovarian-type stroma (C & D), consistent with a low-grade mucinous cystic neoplasm. Many areas of the cyst are denuded and lined by granulation tissue with fibrinous exudate, cholesterol cleft and calcifications, with extensive surrounding fibrosis.
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Microscopically, they were lined by flat low-grade foveolar-type and focal pancreaticobiliary-type epithelium with focal ovarian-type stroma, consistent with low-grade mucinous cystic neoplasm (Fig. 3).