A case report of a 39-year-old male with choledochal cyst mimicking pancreatic pseudocyst

In European countries, choledochal cysts are rare anomalies of the bile tract. At the Surgery Department of the University Hospital Ostrava, a case of a patient with cystic lesion of the pancreatic head was solved. According to ultrasonography and computer tomography it was assumed to be a pancreatic pseudocyst. Only after a complete additional examination of the pancreatico-biliary system, was it diagnosed Ia-type cystic dilatation of the common bile duct, accompanied by stenosis in its terminal part. With regard to the age of the first clinical symptoms, their character and histopathological findings, congenital origin is assumed in both of these anomalies. After provisional percutaneous transhepatic biliary drainage, a duodenohemipancreatectomy was performed with complete cyst excision. Until now, nine months later, the patient has shown absolutely no clinical difficulties.     

Adrenal pseudocyst mimicking cancer: a case report

Adrenal cysts are infrequently observed, since less than 500 cases have been reported in Western literature. Adrenal cysts are conventionally divided into four categories: epithelial, parasitic, endothelial, and hemorrhagic. They are characterized by different etiological and pathological features. Some authors suggest that endothelial and hemorrhagic cysts are related and may represent a spectrum of lesions. We report herein the case of an adrenal hemorrhagic pseudocyst that simulated adrenocortical cancer and argue on the clinical clues for a differential diagnosis with other adrenal tumors.     

Choledochal cyst during pregnancy: case report and literature review of treatment

Choledochal cysts are uncommon conditions, usually diagnosed during childhood, but rarely during pregnancy. Choledochal cysts during pregnancy carry several risks, including development of biliary tract cancer and peritonitis due to rupture of dilated cysts induced by pregnancy itself. We present here a case of choledochal cyst during pregnancy, and discuss appropriate treatments for choledochal cysts first presenting during pregnancy. A 25-year-old primigravida at 15 weeks’ gestation was admitted to our hospital with abdominal pain. Magnetic resonance cholangiopancreatography diagnosed a type 1 choledochal cyst without a mass lesion. A healthy baby arrived without complication at 38 weeks’ gestation. The patient underwent cholecystectomy and choledochal cyst excision. The postoperative course was uneventful with discharge on day 8. Pathological examination diagnosed no malignant feature. Surgery may be performed after delivery for choledochal cysts first presenting during pregnancy, and monitoring with magnetic resonance imaging, blood tests, and ultrasonography is necessary during observation.     

Intrasplenic pancreatic pseudocyst: a case report.

An intrasplenic pseudocyst associated with the acute relapsing phase of chronic pancreatitis in a 51-year-old woman is reported, with a review of the Japanese literature. The patient was admitted with a complaint of left lateral and back pain. Abdominal US and CT revealed communicating cysts at the pancreatic tail and the subcapsule of the spleen. A repeat US and CT 1 month after admission demonstrated enlargement of the cyst at the pancreatic tail. ERCP revealed a dilated main pancreatic duct without any definite evidence of stenosis, and direct communication with the cyst at the pancreatic tail. Percutaneous cystography revealed that the subcapsular cyst of the spleen, the cyst of the pancreatic tail, and the main pancreatic duct communicated with each other. The cyst contained serous fluid with an amylase content of 57,500 IU/I. Distal pancreatectomy and splenectomy was performed. Histologically, there was a nonepithelial lining on the inner surface of the cysts at the pancreatic tail and the subcapsule of the spleen. Severe chronic inflammatory changes were present in the resected tail of the pancreas. Timely surgical treatment is advocated to reduce the mortality and morbidity associated with complications of intrasplenic pseudocysts.     

Intrasplenic pancreatic pseudocyst: A case report

An intrasplenic psudocyst associated with the acute relapsing phase of chronic pancreatitis in a 51-year-old woman is reported, with a review of the Japanese literature. The patient was admitted with a complaint of left lateral and back pain. Abdominal US and CT revealed communicating cysts at the pancreatic tail and the subcapsule of the spleen. A repeat US and CT 1 month after admission demonstrated enlargement of the cyst at the pancreatic tail. ERCP revealed a dilated main pancreatic duct without any definite evidence of stenosis, and direct communication with the cyst at the pancreatic tail. Percutaneous cystography revealed that the subcapsular cyst of the spleen, the cyst of the pancreatic tail, and the main pancreatic duct communicated with each other. The cyst contained serous fluid with an amylase content of 57,500 IU/I. Distal pancreatectomy and splenectomy was performed. Histologically, there was a nonepithelial lining on the inner surface of the cysts at the pancreatic tail and the subcapsule of the spleen. Severe chronic inflammatory changes were present in the resected tail of the pancreas. Timely surgical treatment is advocated to reduce the mortality and morbidity associated with complications of intrasplenic pseudocysts.     

Choledochal cyst disease: A review

The authors present a review of the classification, etiology, presentation, treatment and long-term outcome of children and adults with choledochal cyst disease. Unlike children, adults often present with acute biliary tract symptoms or pancreatitis. The treatment of choice remains extrahepatic cyst excision and biliary bypass. This treatment has excellent long-term results that minimize the development of malignancy.     

仅表现为胰腺多发囊肿的Von Hippel-Lindau病一例并文献综述

患者男性．37岁。主诉“体重下降1个月”于2005年3月入院。患者1个月前无明显诱因出现体重下降，食欲及进食量较前无明显变化，无腹痛、腹淀，无多饮、多食、多尿，无低热、盗汗，病程中大小便正常，体重下降约5kg。既往2年前外院诊断“2型糖尿病”，平素规律服用达美康80mg bid，血糖空腹及餐后控制在正常范围。     

Autoimmune pancreatitis associated with a large pancreatic pseudocyst that disappeared after corticosteroid therapy: a case report and literature review

A 51-year-old woman was admitted to our department because of upper abdominal pain. The serum IgG4 concentration was elevated, and abdominal computed tomography revealed diffuse enlargement of the pancreas associated with a large cyst, measuring 8 cm in diameter. Endoscopic retrograde cholangiopancreatography revealed narrowing of the main pancreatic duct (from the body to the tail), narrowing of the intrapancreatic bile duct, and dilatation of the bile ducts. The patient was given a diagnosis of autoimmune pancreatitis (AIP) associated with a pancreatic pseudocyst and intrapancreatic bile duct stenosis. Oral steroid therapy resulted in reduced pancreatic swelling, complete disappearance of the pancreatic cyst, and an improvement in biliary stenosis. AIP is rarely associated with pancreatic cyst, and only 13 cases, including ours, have been reported to date. In our patient, intense inflammation apparently led to cyst formation in association with AIP, which responded remarkably to corticosteroid therapy. Correct diagnosis of AIP associated with a pancreatic pseudocyst might save patients from undergoing unnecessary endoscopic and surgical procedures.     

Pancreatic tuberculosis mimicking pancreatic head carcinoma: A case report and review of the literature

Summary A 24-year-old man presented with vague abdominal fullness and a mild epigastric dull pain for about 3 months was found to have a pancreatic head tumor at a medical center 2 months ago. He came to our hospital for further treatment. Ultrasonography, endoscopic retrograde cholangiopancreatography (ERCP) and abdominal computed tomography (CT) all revealede a pancreatic head tumor. Laparotomy was performed because pancreatic head carcinoma was highly suspected. Indurated mass in the pancreatic head, enlarged lymph nodes and white tubercles on the intestine proved to be tuberculosis on histological examination of a frozen section. Acid fast bacilli were also found. The patient was given antituberculous therapy and is now doing well. To avoid unnecessary laparotomy, CT, echo-guided percutaneous aspiration cytology or biopsy and culture of the tissue for mycobacteria should be done in a patient with pancreatic mass, especially in a region where pulmonary and abdominal tuberculosis are common.

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Pankreastuberkulose unter dem Bild eines Pankreaskopfkarzinoms; Fallbericht und Literaturübersicht

Zusammenfassung Ein 24jähriger Mann klagte seit drei Monaten über unklares abdominelles Völlegefühl und einen dumpfen, leicht epigastrischen Schmerz. Zwei Monate vor Aufnahme war in einem klinischen Zentrum ein Pankreaskopftumor festgestellt worden. Sonographisch, durch endoskopische retrograde Cholangiopankreatographie und Computertomographie des Abdomens wurde der Pankreaskopftumor bestätigt. Wegen des hochgradigen Verdachtes auf Pankreaskopfkarzinom wurde eine Laparotomie vorgenommen. Dabei fand sich im Pankreaskopf eine indurierte Masse, vergrößerte Lymphknoten und weiße Tuberkel auf dem Darm. Die histologische Untersuchung bestätigte das Vorliegen tuberkulöser Granulome. Säurefeste Stäbchen konnten histologisch ebenfalls nachgewiesen werden. Der Patient wurde mit Tuberkulostatika behandelt und ist jetzt in guter Verfassung. Um unnötige Laparotomien zu vermeiden, sollte bei Patienten mit Pankreastumor eine computertomographisch oder sonographisch kontrollierte Aspirationsbiopsie mit zytologischer oder histologischer Untersuchung durchgeführt und auch kulturell der Nachweis von Mykobakterien versucht werden. Dies gilt vor allem für Regionen, in denen die Lungentuberkulose und abdominelle Tuberkulosen keine Seltenheit darstellen.

     

Pancreatic pseudocyst located in the liver: a case report and literature review

Pancreatic pseudocyst in the liver is a rare complication of acute or chronic pancreatitis. However, its frequency seems to be increasing with modem imaging procedures. The authors report a case of pancreatic pseudocyst involving the left lobe of the liver that occurred in a patient who never showed clinical evidence of pancreatitis or pancreatic injury. Complete screening led to the discovery of alcoholic chronic pancreatitis. The pseudocyst was treated successfully by radiologic drainage. The pancreatic pseudocyst location and therapeutic approaches are discussed. A literature review uncovered 26 cases of hepatic pancreatic pseudocysts. Clinical presentation, imaging characteristics, and treatment of these cases are analyzed.     

Catastrophic antiphospholipid syndrome mimicking a malignant pancreatic tumour--a case report

The catastrophic antiphospholipid syndrome is characterised by rapid onset thromboses, often resistant to conventional anticoagulant treatment, and resulting in life threatening multiple organ dysfunction. The diagnosis of catastrophic antiphospholipid syndrome may be difficult, predominantly due to its frequently atypical presentation. We report a case of a 35-year-old female who presented with a pancreatic tumour and extensive thromboses. Following a storm of ischemic events due to thrombotic occlusions in spite of therapeutic heparin dose, the suspicion of catastrophic antiphospholipid syndrome emerged. The patient was successfully treated with anticoagulants, immunoglobulins, plasmapheresis and rituximab. The present report shows that the use of the diluted Russell's viper venom time can be helpful in providing additional information on the lupus anticoagulants antibody status, allowing careful monitoring of lupus anticoagulants conversion and hence response to therapy.     

Appendiceal hydatid cyst: a case report and review of literature

Hydatid cyst has a predilection to involve liver and lungs. Most of the reported cases of appendiceal hydatid cyst are primary, and secondary involvement has been rarely reported in the English-language literature. Herein, we report a 47-year-old man who presented with abdominal pain, fatigue, and anorexia since 6 months ago. He had history of surgery for hepatic hydatid cyst 7 years ago. Diagnosis of secondary hydatidosis was made upon positive indirect hemagglutination assay and abdominopelvic computed tomography scan, which showed involvement of liver, appendix, and spleen. Albendazole was started, and surgical cystectomy, appendectomy, and splenectomy were performed. Albendazole was continued postoperatively for 6 months. During this period, liver function test and abdominal sonography were normal. Despite its rarity, our case emphasizes that primary care physicians should have high index of clinical suspicion of secondary hydatidosis of appendix when they detect cystic mass, especially in patients with previous hepatic hydatid disease.