A RESECTED CASE OF DUCTECTATIC TYPE CYSTADENOMA OF THE PANCREAS

It is not always easy to make a differential diagnosis of cystic lesion of the pancreas whether it is a cyst, cystadenoma, or cystadenocarcinoma. Particularly cystic lesions with the size of less than several centimeter which can be detected by ERP, ultrasonography, and CT scan often have atypical papillary hyperplasia, which poses a problem whether it is reactive or tumorous. This paper describes our experience with a case of ductectatic type cystadenoma of the pancreas which was difficult to differentiate from mucous-producing cancer of the pancreas preoperatively. A 53-year-old was admitted to the hospital because of right hypochondraligia. Computed tomographic examination showed a low density area in the head of the pancreas. Pancreaticoduodenectomy was performed when endoscopic retrograde pancreaticography (ERP) showed dilatation of the main pancreatic duct and cystic dilatation of the lesser ducts with a filling defect. Pathological findings revealed atypical papillary hyperplasia with staining by anti-CEA monoclonal antibody and goblet cell metaplasia. Further investigations to diagnose the pancreatic cystic lesions whether cancerous or not are necessary measuring oncogene expression such as K-ras point mutation.