We report a case of a patient in whom a giant
mucinous cystadenocarcinoma was treated with distal
pancreatectomy. A 37-year-old woman was admitted to the hospital complaining of intermittent epigastric
pain. The laboratory data revealed a marked increase in serum levels of
carcinoembryonic antigen( CEA 22 ng/mL),
cancer antigen( CA) 19-9( 258,129 U/ mL), and CA125 (53 U/mL). A computed tomography (CT) scan revealed a cystic
tumor, 15 cm in diameter, in the body of the pancreas. The
tumor presented as a multilocular
cyst with enhanced nodules. On positron emission tomography (PET)-CT,[
18F] fluorodeoxyglucose uptake by the nodules of the
cyst was noted. Under the diagnosis of malignant mucinous
cystic neoplasm, we performed distal
pancreatectomy,
splenectomy, partial
gastrectomy, and left
adrenalectomy because the
tumor was suspected to be invading the stomach and left adrenal gland. The
tumor was histologically diagnosed as invasive
mucinous cystadenocarcinoma with ovarian-like stroma. The patient survived for 14 months after surgery without
tumor recurrence. Invasive
mucinous cystadenocarcinoma of the pancreas has high rates of
lymph node metastasis and early recurrence after surgery. We believe that we would have had to perform complete
tumor resection equivalent to that of invasive
ductal carcinoma of the pancreas if the mucinous
cystic neoplasm was found to be malignant preoperatively.