Giant Mucinous Cystadenoma Of The Pancreas: A Rare Aetiology Of An Abdominal Tumor, A Case Report

摘要

Cystic tumors of the pancreas represent less than 10 % of all the cystic hurts of this organ. Among them, mucinous cystadenomas constitute a very particular anatomo-pathological entity with malignant potential. The purpose of this work is to report a particular case by its clinical presentation display, its size, and the surgical treatment which ensued. We discuss the diagnostic and therapeutic aspects of this condition. Introduction Cystic tumors of the pancreas represent less than 10 % of all the cystic conditions of this organ. Among them, mucinous cystadenomas constitute a very particular anatomo-pathological entity. This pathology defines itself as being a cystic tumor with malignant potential. Its preoperative diagnosis is increasingly refined by the advances of the imaging combined in the draining cystic intra under echo-endoscopy. The purpose of this case report is to describe a particular case by its clinical presentation, its size, and its surgical treatment. We discuss the diagnostic and therapeutic aspects of this condition. Observation A 30-year-old patient, without particular pathological histories was admitted for an abdominal tumefaction evolving during the past 8 months associated with epigastric abdominal pain and occasional vomiting which calmed the pain. On examination, we found a patient in good general condition with normal constants, an enormous abdominal mass measuring 15cm on 20cm, firm, painless, mobile compared with the superficial plan. Laboratory investigations showed an anaemia with a rate of haemoglobin in 9,9g / dl.The tomodensitometry showed (figure 1) a voluminous cystic mass with fine walls contrast enhancing and developed at the pancreas tail. There were no partitions either of vegetations or calcifications. The neighboring pancreatic parenchyma was of normal aspect and Wirsung duct was not dilated.The dosage of plasmatic C19-9 had returned normal for 15,7 KU / L.During median laparotomy we found a voluminous cystic mass of the pancreas tail (figure 2) which contracted multiple adhesions with the transverse colon, small bowel, left kidney and its vein, and the splenic pedicle.After careful dissection, a left splenopancreatectomy taking the tumor was realized associated with an resection-anastomosis of the adjacent transverse colon. The post-operative care consisted of a triple vaccination (anti meningococcus, anti pneumococcus and anti Haemophilus influenzae) and an antibioprophylaxy with Oracilline. Surgical pathology showed a cystic formation which weighed 4kg with thick and fibrous wall lined on its internal face by a cylindrical epithelial cover secreting mucus. We found some islands of endocrine atrophic cells in periphery or in the shell. There were no suspicious signs of wickedness. The pancreatic section was healthy. The examination ended in a diagnosis of pancreatic mucinous cystadenoma without formal histological signs of wickedness. Discussion Cystic tumors of the pancreas represent 10 to 15 % of all the pancreatic cysts and approximately 1 % of the pancreatic cancers [1]. The mucinous cystadenoma is a tumor slow in devolvement and does not tend to regression. It is a macrocystic tumor united or oligo cystic (less than 6 cysts) limited by a cylindrical mucinous secreting epithelium basing on a pseudo-ovarian stroma with richl cellular content.The ascendancy is feminine with an average age of 60 years as described by Hardacre [1,2]. However, this pathology was also found in patients much younger as in our case [1,4].The clinical signs are not specific. The discovery is increasingly fortuitous with the progress of imaging. Our patient was symptomatic and presented with epigastric pains and abdominal mass.The morphological diagnosis calls on to the combination of several examinations in particular the ultrasound, the Scanner, the MRI, the echo-endoscopy. All these examinations complement each other and their association allows to increase the efficiency of the diagnosis. Lewin [5] co