Difficulties in the preoperative assessment of pancreatic cystic lesions: a case report

Abstract

Introduction: Conventional diagnostic instruments encounter great difficulties in the preoperative assessment of pancreatic lesions. Also preoperative histological diagnosis is not trustworthy as there is a high rate of false negatives and differential diagnosis can often fail. Case Report: We report a case of a young woman with instrumental diagnosis of a suspect malignant pancreatic cystic lesion. The patient underwent distal splenopancreasectomy and histological examination of the specimen revealed an Intraductal Papillary Mucinous Neoplasm (IPMN) associated to a Mucinous Cystic Neoplasm (MCN) and an unexpected small neuroendocrine tumor in the pancreatic tail. Discussion: Not all pancreatic neoplasms need a radical surgical treatment which is associated to high morbidity and mortality rates. Nevertheless it is indicated in all cases of MCN with signs of malignant transformation, in main- and branch duct IPMN and in case of pancreatic neuroendocrine tumors if they are singular and in M0 stage. So a certain preoperative histological diagnosis would be desirable. Conclusions: A preoperative definite histological diagnosis, in case of cystic and neuroendocrine neoplasms of the pancreas, is often not feasible. So many patients undergo surgery with the suspect of pancreatic neoplasm as the certain histological diagnosis can only be made on the specimen