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Case 225

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15 year-old female patient, previously healthy, attends to the emergency room because of mid-abdominal pain, intermittent and vague, of recent onset. No other complaints and without altereations detected in the physical examination. Ultrasonography (US) showed an abdominal mass in the head of the pancreas. A computed tomography (CT) was requested, with oral and intravenous iodinated contrast, for diagnostic investigation (Images 1 and 2).

Considering the reported case and changes in abdominal CT, which is the most likely diagnosis?

a) Pancreatic adenocarcinoma

25%

b) Serous pancreatic cystadenoma

25%

c) Pseudopapillary solid tumor of the pancreas

25%

d) Pancreatic pseudocyst

25%
   

Image analysis

Images 1 and 2: CT abdominal in the axial plane (1) and reconstruction in the coronal plane (2), showing an oval mass, with regular and well-defined contours in the uncinate process of the pancreas, measuring 55mm in its largest diameter. Predominantly cystic in texture, with a slight enhancement by iodinated intravenous contrast on the wall and without internal septa.

Highlights

- The presence of a growing pancreatic mass with cystic and solid components in a young female patient suggests pseudopapillary solid tumor of the pancreas or Frantz tumor;

- They are usually asymptomatic and do not produce laboratory abnormalities;

- CT and MRI can aid in the differential diagnosis of pancreatic lesions;

- Surgical treatment is always indicated.

Bibliography

- Basturk O, Coban I, Adsay NV. Pancreatic cysts: pathologic classification, differential diagnosis, and clinical implications. Arch Pathol Lab Med 2009;133(3):423–438.

- Khan A, Khosa F, Eisenberg RL. Cystic Lesions of the Pancreas. AJR 2011;196: W668-W677.

- Cantisani V, Mortele KJ, Levy A, et al. MR imaging features of solid pseudopapillary tumor of the pancreas in adult and pediatric patients. AJR 2003; 181:395–401.

- ShetNS, Fole BL, Iyer RS. Imaging of Pediatric Pancreatic Neoplasms With Radiologic-Histopathologic Correlation. AJR 2014; 202:1337-1348.

- Tanaka M, Chari S, Adsay V, et al. International Association of Pancreatology. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 2006; 6:17–32.

- Portella AR, Oliveira BRR, Carvalho MG, Cintra CA, Miyata S, Moreira RCL, Salles PGO, César BP. Tumor sólido pseudopapilar do pâncreas (Tumor de Frantz): estudo retrospectivo e revisão da literatura. GED Gastroenterol. Endosc. Dig. 2011: 30(1)13-18.

 Authors

Ana Cláudia Guimarães Carvalho, 6th year medical student at UFMG.

E-mail: anaguimaraescarvalho[at]hotmail.com

          

André Ribeiro Guimarães, 6th year medical student at UFMG.

E-mail: guimaraesandrer[at]hotmail.com

          

Bárbara Cecília Borges Moreira, 6th year medical student at UFMG.

E-mail: barbaracecilia[at]msn.com

Supervisors

Dr. Luciana Costa Silva, Doctor, radiologist specialist in gastroenterology and oncology as well as Associate Professor of the Complementary Assessment Department - FM-UFMG.

 

Dr. Agnaldo Soares Lima, surgeon of the intestinal tract and Associate Professor of the Surgery Department FM- UFMG.

Reviewers

Fellype Borges, Fernando Bottega, Bárbara Queiroz, Cairo Mendes e Profa. Viviane Parisotto.

Translated by

Bárbara de Queiroz e Bragaglia, 6th year medical student at UFMG.

E-mail: barbara.bragaglia[at]gmail.com 

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