Mucinous Cystic Neoplasm of Pancreas in a Male Patient: A Case Report and Review of the Literature
Mohammad Kazem Fallahzadeh, MD; Gazi B. Zibari, MD, FACS, FICS; Greg Wellman, MD; Sophia T. Abdehou, MD; Hosein Shokouh-Amiri, MD, FACS, FICS
Mucinous cystic neoplasms (MCNs) are among the most common primary cystic neoplasms of pancreas. These lesions usually occur in body and tail of the pancreas and are characterized by the presence of ovarian type stroma in the pathological evaluation. Mucinous cystic neoplasms have significant malignant potential; therefore, their diagnosis and resection is of utmost importance. Mucinous cystic neoplasms typically occur in women. Only a few cases have been previously reported in male patients. In this case report, we present a 48-year-old man who was referred to our center due to an incidentally found cystic lesion in the tail of the pancreas that was increasing in size in serial evaluation. The patient underwent open distal pancreatectomy. The pathology showedmucinous cystic neoplasmwith characteristic ovarian type stroma and positive staining for estrogen and progesterone receptors. This case report shows that mucinous cystic neoplasms can occur in men and should be considered in differential diagnosis of cystic pancreatic lesions in this population.
INTRODUCTION Mucinous cystic neoplasms (MCNs) are one of the three most common cystic neoplasms of pancreas and comprise nearly half of these cases. 1 MCNs are usually located in the body and tail of the pancreas and are characterized by the presence of the ovarian type stroma in the pathological evaluation. 1,2 Due to the significant malignant potential of mucinous cystic neoplasms, their diagnosis and resection is of utmost importance. 1,2 MCNs almost always occur in women. 1 Occurrence of MCN in males is very rare and only a few cases have been previously reported. 2-8 In this article, we present a case of MCN in a male patient who was treated at our center. CASE PRESENTATION A 48-year-old Caucasianmale was referred to our clinic because of a cystic mass in the tail of the pancreas. This mass was incidentally found one year prior to the referral to us on a CT scan performed due to an abdominal gunshot wound that resulted in splenectomy. The trauma surgeon did not resect the pancreatic lesion and decided to monitor its progression. On serial abdominal CT scans, the mass in- creased in size from 4.3 x 3.7 cm at the initial CT scan to 4.7 x 4.6 cm one year later (Figure 1). Although the patient was asymptomatic due to the increase in the size and the suspi-
cion of the malignant nature of the lesion, he was referred to us and underwent open distal pancreatectomy. Grossly, the lesion consisted of a 5 x 3 x 2 cmmultilocular cyst in the tail of the pancreas. Microscopically, the cyst demonstrated a flat epithelium, which varied from a mucin-producing columnar epithelium to a cuboidal epithelium (Figure 2, Panel A). No significant atypia was identified. Subjacent to the epithelium, a distinctive ovarian-type stroma was present, composed of densely packed spindled cells with regular elongated and wavy nuclei (Figure 2, Panel A). These nuclei showed strong immunoreactivitywith estrogen and progesterone receptor stains (Figure 2, Panels B and C). After finding this type of pathology, male karyotyping was ordered for the patient. Cytogenetic analysis of bonemarrow aspirate revealed a normal male karyotype. The patient recovered well postoperatively and is symptom-free three months after the surgery. DISCUSSION Based on World Heath Organization (WHO) criteria, MCNs are defined as cystic epitheilal neoplasms composed of mucin producing columnar epithelium and an ovarian- type stroma which forms a band of densely packed stromal cells beneath the epithelium. 1,3 Immunohistochemial stain- ing of the ovarian-type stroma in MCN is usually positive for estrogen and progesterone receptors. 1,2 Presence of this
J La State Med Soc VOL 166 March/April 2014 67
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