2018 Volume 60 Issue 5 Pages 1089-1094
A 76-year-old woman presented to the emergency room of our hospital with the chief complaints of fever and epigastralgia. She had elevated inflammation with an elevated blood C-reactive protein level of 13.7 mg/dL. Contrast computed tomography, magnetic resonance imaging and endoscopic ultrasound revealed multilocular cysts with 70-mm capsules in the pancreatic tail. The lesions had a cyst-in-cyst appearance, and 10-mm mural nodules with a contrast effect were seen in the cysts. Endoscopic retrograde pancreatography showed communication of the cysts with the pancreatic duct. Examination of the cyst fluid showed an increased number of neutrophils and positivity for Escherichia coli by bacterial culture. Based on the above findings, the diagnosis of pancreatic mucinous cystadenocarcinoma with bacterial infection was made, and distal pancreatectomy was performed. Pathologically, an ovary-like interstitium was seen in the cyst wall, and the mural nodules were adenocarcinoma. When dealing with infectious pancreatic cysts, it is necessary to consider treatment methods while keeping in mind the possibility of neoplastic cysts.
