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Kori M, Tsunematsu M, Yao R, Hamura R, Yoda A, Endo H, Horiuchi T, Abe K, Hisa T, Onda S. Successful laparoscopic resection for giant mature cystic teratoma of the pancreas: a case report and surgical refinements. Surg Case Rep 2024; 10:115. [PMID: 38722483 PMCID: PMC11082099 DOI: 10.1186/s40792-024-01918-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/02/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Mature cystic teratomas or dermoid cysts of the pancreas complicate surgical approaches because of their anatomical position and ever-growing size. Herein, we report a case of a giant mature cystic teratoma of the pancreas that was successfully resected via complete laparoscopic distal pancreatectomy (LDP). CASE PRESENTATION A 39-year-old female patient was referred to our hospital for the evaluation of a pancreatic tumor. Three years of follow-up revealed that the tumor had increased in size to 18 cm, with hyperintense solid components on diffusion-weighted magnetic resonance imaging. Considering the possibility of malignancy, we decided to perform an LDP. The capsule appeared solid enough to withstand the retraction of the endoscopic forceps. Tumor size made it difficult to dissect the dorsal side of the tumor from the caudal to the cranial side. Early transection of the pancreas and additional ports facilitated dissection of the dorsal side of the tumor. We completed the LDP without intraoperative cyst rupture. On pathological examination, the tumor was diagnosed as a mature cystic teratoma originating from the pancreatic tail. The patient was discharged on postoperative day 13 with no complications. CONCLUSION LDP may be an option for surgical procedures in patients with large cystic lesions of the pancreatic body or tail. Intraoperative observation of the tumor and surgical refinement are necessary to complete the laparoscopic procedure without tumor rupture.
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Affiliation(s)
- Mayuko Kori
- Department of Digestive Surgery, Saku Central Hospital Advanced Care Center, 3400-28, Nakagomi, Saku, Nagano, 385-0051, Japan
| | - Masashi Tsunematsu
- Department of Digestive Surgery, Saku Central Hospital Advanced Care Center, 3400-28, Nakagomi, Saku, Nagano, 385-0051, Japan.
| | - Ran Yao
- Department of Digestive Surgery, Saku Central Hospital Advanced Care Center, 3400-28, Nakagomi, Saku, Nagano, 385-0051, Japan
| | - Ryoga Hamura
- Department of Digestive Surgery, Saku Central Hospital Advanced Care Center, 3400-28, Nakagomi, Saku, Nagano, 385-0051, Japan
| | - Atsushi Yoda
- Department of Digestive Surgery, Saku Central Hospital Advanced Care Center, 3400-28, Nakagomi, Saku, Nagano, 385-0051, Japan
| | - Hidetoshi Endo
- Department of Digestive Surgery, Saku Central Hospital Advanced Care Center, 3400-28, Nakagomi, Saku, Nagano, 385-0051, Japan
| | - Takashi Horiuchi
- Department of Digestive Surgery, Saku Central Hospital Advanced Care Center, 3400-28, Nakagomi, Saku, Nagano, 385-0051, Japan
| | - Kyohei Abe
- Department of Digestive Surgery, Saku Central Hospital Advanced Care Center, 3400-28, Nakagomi, Saku, Nagano, 385-0051, Japan
| | - Takeshi Hisa
- Department of Gastroenterology, Saku Central Hospital Advanced Care Center, 3400-28, Nakagomi, Saku, Nagano, 385-0051, Japan
| | - Shinji Onda
- Department of Digestive Surgery, Saku Central Hospital Advanced Care Center, 3400-28, Nakagomi, Saku, Nagano, 385-0051, Japan
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Vlăduţ C, Bilous D, Ciocîrlan M. Real-Life Management of Pancreatic Cysts: Simplified Review of Current Guidelines. J Clin Med 2023; 12:4020. [PMID: 37373713 DOI: 10.3390/jcm12124020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Pancreatic cysts are becoming a popular diagnostic tool due to the increased availability of high-quality cross-sectional imaging. Pancreatic cystic lesions constitute closed, liquid-containing cavities, which are either neoplastic or non-neoplastic. While serous lesions often follow a benign course, mucinous lesions can hide carcinoma and, therefore, require different management. Moreover, all cysts should be considered mucinous until proven otherwise, thus limiting the errors in managing these entities. Due to the need for high contrast soft tissue imaging, magnetic resonance imaging represents an elective, non-invasive diagnostic tool. Endoscopic ultrasound (EUS) has started gaining more prominence with regard to the proper diagnosis and management of pancreatic cysts, offering quality information with minimal risks. Enabling both the acquisition of endoscopic images of the papilla and the endosonographic high-quality evaluation of septae, mural nodules along with the vascular patterns of the lesion contribute to a definitive diagnosis. Moreover, the possibility of obtaining cytological or histological samples could become mandatory in the foreseeable future, allowing for more precise molecular testing. Future research should focus on detecting methods to quickly diagnose high-grade dysplasia or early cancer for patients with pancreatic cysts, thus allowing time for appropriate treatment and avoiding surgical overtreatment or over surveillance in selected cases.
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Affiliation(s)
- Cătălina Vlăduţ
- Department 5, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Gastroenterology Department, "Prof Dr Agrippa Ionescu" Emergency Hospital, 011356 Bucharest, Romania
| | - Dana Bilous
- Gastroenterology Department, "Prof Dr Agrippa Ionescu" Emergency Hospital, 011356 Bucharest, Romania
| | - Mihai Ciocîrlan
- Department 5, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Gastroenterology Department, "Prof Dr Agrippa Ionescu" Emergency Hospital, 011356 Bucharest, Romania
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Tasis N, Prountzopoulou AA, Skafida E, Arnaouti M, Tsirlis T, Plastiras A, Manatakis DK, Arnogiannaki N, Korkolis DP. Giant teratoma of the pancreas expanding to the mediastinum: Rare tumor and literature review. Rare Tumors 2022; 14:20363613221147470. [PMID: 36601383 PMCID: PMC9806373 DOI: 10.1177/20363613221147470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 12/07/2022] [Indexed: 12/27/2022] Open
Abstract
Pancreatic mature cystic teratomas are very rare with limited cases found in the literature. These lesions raise a diagnostic challenge and complicate the surgical approach not only because of their anatomic position but also because of their ever-growing size. An elusive diagnosis, usually leads to the operative theatre where surgical resection takes place. We present a rare case of a large pancreatic cystic teratoma extending into the mediastinum in a 29-year-old woman which was succesfully managed with en-bloc distal pancreatectomy and spleenectomy.
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Affiliation(s)
- Nikolaos Tasis
- Department of Surgical Oncology, St Savvas Cancer
Hospital, Athens, Greece,2nd Department of Surgery, Athens Naval and Veterans
Hospital, Athens, Greece,Nikolaos Tasis, Department of Surgical
Oncology, St Savvas Cancer Hospital, Dimitsanas 1, Athens 11522, Greece.
| | | | | | - Maria Arnaouti
- Department of Pathology, St Savvas Cancer
Hospital, Athens, Greece
| | - Theodoros Tsirlis
- Department of Surgical Oncology, St Savvas Cancer
Hospital, Athens, Greece
| | - Aris Plastiras
- Department of Surgical Oncology, St Savvas Cancer
Hospital, Athens, Greece
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Djokic M, Hadzialjevic B, Rankovic B, Dezman R, Tomazic A. Neuroendocrine Tumor Arising within Mature Cystic Teratoma of the Pancreas: Literature Review and Case Report. Curr Oncol 2022; 29:4717-4724. [PMID: 35877234 PMCID: PMC9322391 DOI: 10.3390/curroncol29070374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/29/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022] Open
Abstract
Cystic teratomas are germ cell tumors most commonly found in the ovaries and testes. The pancreas, however, is very rare as a site of occurrence. Moreover, only two cases of cystic teratoma with concomitant neuroendocrine tumor have been reported to date. We report the case of a 33-year-old female who presented with abdominal pain. Computed tomography and magnetic resonance imaging of the upper abdomen revealed an 85 mm cystic tumor in the head of the pancreas. Cystic teratoma and mucinous cystadenoma were suggested as differential diagnoses. Cytopathologic analysis of endoscopic ultrasound-guided fine needle aspiration was consistent with mucinous cystadenoma. Therefore, the patient underwent surgical resection. Histologic analysis revealed a mature cystic teratoma of the pancreas with a concomitant neuroendocrine tumor. The patient is in great condition at 8 months follow-up. Cystic teratoma of the pancreas with a concomitant neuroendocrine tumor is an extremely rare condition. Surgical resection remains the mainstay of treatment as it provides a definitive diagnosis and no recurrences have been reported to date.
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Affiliation(s)
- Mihajlo Djokic
- Department of Abdominal Surgery, Ljubljana University Medical Center, Zaloska Cesta 7, 1000 Ljubljana, Slovenia; (M.D.); (B.H.)
- Department of Surgery, Faculty of Medicine, University of Ljubljana, Zaloska Cesta 7, 1000 Ljubljana, Slovenia
| | - Benjamin Hadzialjevic
- Department of Abdominal Surgery, Ljubljana University Medical Center, Zaloska Cesta 7, 1000 Ljubljana, Slovenia; (M.D.); (B.H.)
| | - Branislava Rankovic
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Korytkova Ulica 2, 1000 Ljubljana, Slovenia;
| | - Rok Dezman
- Department of Radiology, Ljubljana University Medical Center, Zaloska Cesta 7, 1000 Ljubljana, Slovenia;
| | - Ales Tomazic
- Department of Abdominal Surgery, Ljubljana University Medical Center, Zaloska Cesta 7, 1000 Ljubljana, Slovenia; (M.D.); (B.H.)
- Department of Surgery, Faculty of Medicine, University of Ljubljana, Zaloska Cesta 7, 1000 Ljubljana, Slovenia
- Correspondence:
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Zhou XH, Ma JK, Valluru B, Sharma K, Liu L, Hu JB. Diagnosis and differentiation of mature cystic teratoma of pancreas from its mimics: A case report. Medicine (Baltimore) 2020; 99:e23267. [PMID: 33217853 PMCID: PMC7676578 DOI: 10.1097/md.0000000000023267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Mature cystic teratoma originating in the pancreas is very unusual, often observed as an incidental finding during routine examinations or recognized perioperatively as the patients present with very unspecific clinical symptoms. The confirmatory diagnosis of a pancreatic cystic teratoma is generally made by histopathology after surgical excision. So, the preoperative diagnosis is very challenging, especially differentiation from the other pancreatic pathologies. PATIENT CONCERNS A 23-year-old woman was admitted to our hospital with a complaint of mild grade periumbilical abdominal pain. A pancreatic mass was revealed on a preliminary abdominal ultrasound examination. Her medical history was unremarkable with no long-standing illness or malignancy. DIAGNOSIS Mature cystic teratoma in the head of the pancreas. INTERVENTIONS Roux-enY choledochojejunostomy with gastrojejunostomy was performed, excising the tumor from the pancreatic head. OUTCOMES The postoperative course was uneventful; the patient was asymptomatic and has no evidence of recurrence on a 2-year follow up. CONCLUSIONS Pancreatic cystic teratoma is a benign, well-differentiated, and extremely rare congenital tumor. MRI is the choice of imaging modality and phase-GRE or fat suppression is the best technique for pre-operative diagnosis.
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Affiliation(s)
- Xin he Zhou
- Department of Radiology, the First Affiliated Hospital of Dali University
| | - Ji Kong Ma
- Department of Nephrology, Dali Bai Autonomous Prefecture People's Hospital Dali 671000, China
| | - Bimbadhar Valluru
- Department of Radiology, the First Affiliated Hospital of Dali University
| | - Kalyan Sharma
- Department of Radiology, the First Affiliated Hospital of Dali University
| | - Ling Liu
- Department of Radiology, the First Affiliated Hospital of Dali University
| | - Jin Bo Hu
- Department of Radiology, the First Affiliated Hospital of Dali University
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Lee SJ, Shin SS, Heo SH, Jeong YY. Pictorial Review of Rare Pancreatic Tumors and Tumor-Like Lesions. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:1134-1150. [PMID: 36238034 PMCID: PMC9431853 DOI: 10.3348/jksr.2020.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/28/2020] [Accepted: 04/09/2020] [Indexed: 11/21/2022]
Abstract
췌장에는 다양한 종류의 종양 및 종양 유사 병변들이 생길 수 있다. 이 가운데, 췌장선암은 췌장의 가장 흔한 종양으로서 일반적으로 췌장암이라고 하면 이 종양을 가리킨다. 최근에는 영상 검사의 기술적 진보와 이용이 증가하면서 췌장의 희귀 종양 및 종양 유사 병변들의 발견 빈도가 증가하고 있다. 췌장의 드문 종양 및 종양과 유사한 병변들은 치료 방침과 예후가 췌장선암과 다르기 때문에 이들 질환의 감별은 임상적으로 중요한 의의가 있다. 영상 검사는 포상세포암이나 신경초종 등의 희귀 종양 및 자가면역 췌장염 또는 염증성 거짓종양과 같은 종양 유사 병변들과 췌장선암의 감별 진단에 중요한 역할을 하지만 영상 소견만으로 이들 질환을 정확히 구분하는 것은 한계가 있다. 이 논문에서는 췌장에서 생길 수 있는 희귀 종양 및 종양 유사 병변들의 다양한 영상 소견들과 췌장선암과의 감별에 있어 도움이 되는 특징들을 제시하고자 한다.
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Affiliation(s)
- Seung Jae Lee
- Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Sang Soo Shin
- Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Suk Hee Heo
- Department of Radiology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Yong Yeon Jeong
- Department of Radiology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, Korea
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Kim H, Koh Y. Mature Cystic Teratoma of the Pancreas: A Rare Cystic Neoplasm. Open Med (Wars) 2019; 14:872-874. [PMID: 31844677 PMCID: PMC6884920 DOI: 10.1515/med-2019-0102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/30/2019] [Indexed: 12/29/2022] Open
Abstract
Mature cystic teratoma of the pancreas is an extremely rare benign neoplasm. Only 51 cases have been reported in the literature. Its cystic nature often appears to have malignant potential in preoperative image studies. Moreover, no characteristic features could be shown on image studies, such as abdominal CT scan or pancreas MRI. The accurate diagnosis is generally obtained after surgical resection. We present a rare case of a 53-year-old male with mature cystic teratoma of the pancreas, which was confirmed on pathology after laparoscopic distal pancreatectomy.
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Affiliation(s)
- HeeJoon Kim
- Department of General Surgery, Chonnam National University Hwasun Hospital, 58128 Hwasun-gun, South Korea
| | - YangSeok Koh
- Department of General Surgery, Chonnam National University Hwasun Hospital, 58128 Hwasun-gun, South Korea
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