Mixed Serous-Mucinous Cystic Neoplasm of the Pancreas

Abstract

A 47-year-old male presented to the clinic with complaints of general weakness, decreased appetite, and non-specific pain in the right upper quadrant of the abdomen, which had persisted for the past 3 months. The patient had experienced weight loss (approximately 7 kg). The complaints were progressive in nature.                                                                                                                           

The patient's medical history included hypertension, which was controlled with medication. He had undergone cholecystectomy 8 years prior due to cholelithiasis. Family history was significant for gastrointestinal malignancies (father - gastric cancer, mother - pancreatic cancer). The patient was a non-smoker and consumed alcohol moderately.                                                              

Physical examination revealed mild tenderness in the right upper quadrant of the abdomen, without palpable masses. Laboratory studies showed mild elevation of amylase and lipase levels, while liver function tests were within normal limits. The CA 19-9 tumor marker was slightly elevated.                                                                                                                              

Contrast-enhanced computed tomography revealed a 6.5 cm diameter cystic lesion at the junction of the pancreatic body and tail, with heterogeneous density and internal septations. Magnetic resonance cholangiopancreatography (MRCP) confirmed the cystic lesion, which was not connected to the pancreatic ductal system. Endoscopic ultrasound with fine-needle aspiration (EUS-FNA) revealed high-viscosity fluid containing mucin and atypical cells.                                               

The differential diagnosis included:

1. Mixed serous-mucinous cystic neoplasm
2. Intraductal papillary mucinous neoplasm (IPMN)
3. Mucinous cystic neoplasm (MCN)
4. Solid pseudopapillary neoplasm
5. Pancreatic pseudocyst

Cytological examination results, radiological findings, and clinical characteristics suggested a diagnosis of mixed serous-mucinous cystic neoplasm with malignant potential.

Laparoscopic distal pancreatectomy with splenectomy was planned and performed. During the operation, it was found that the cystic lesion had not invaded adjacent tissues. Complete resection of the lesion was performed with negative surgical margins. Histopathological examination confirmed mixed serous-mucinous cystic neoplasm without signs of invasion; however, foci of dysplasia were identified, indicating malignant potential. Lymph nodes were negative for malignancy.

The patient's condition was assessed at 3, 6, and 12 months post-surgery. Control CT studies at 6 and 12 months showed no signs of recurrence or metastasis. Glucose tolerance testing revealed mild glucose metabolism impairment, which was controlled with diet. Annual CT surveillance and tumor marker monitoring are recommended for the next 5 years.

This case represents an example of successful surgical treatment of a rare pancreatic cystic neoplasm, where timely diagnosis and a multidisciplinary approach in developing the treatment strategy were crucial.