This is a wondrous case. Submucosal cysts of the stomach are rare enough, but to have one complicated by an intraductal papillary mucinous tumor is quite extraordinary. The authors stated that there was no ectopic pancreatic tissue in the cyst, which, of course, would have provided an easy explanation of from where the adenocarcinoma arose. Thus, one is drawn to question the nature of the cyst lining: was it gastric or biliary-pancreatic? Immunostaining helped but still indicated a probable rather than a definite diagnosis. Moreover, what began as one epithelial lining could have evolved into another by metaplasia, eventuating in tissue capable of forming papillary excrescences and secreting mucin. Alas, just as in life, there are no new beginnings, just new endings.
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