A CASE REPORT OF SOLID AND CYSTIC TUMOR (SCT)

OF THE PANCREAS AND LITERATURE REVIEW OF 126 CASES IN JAPAN

Abstract

A 52-year-old woman was admitted to our hospital because of further examination of a pancreatic tumor. Extra-abdominal and endoscopic ultrasonogram showed a well-defined tumor echo with mixture of hypoechoic and echogenic areas at the pancreatic head. Abdominal CT showed encapsulated polycystic mass about 7 cm in diameter. A small calcification was also seen in the capsule. Endoscopic pancreatography showed tapering of the main pancreatic duct at the pancreatic body. Selective angiography through the gastroduodenal artery showed widely stretched and compressed arteries near the tumor. Pancreatoduodenectomy was performed because of pancreatic cystic tumor. Macroscopically, the tumor was 9.0 × 9.0 × 8.0 cm in size, encapsulated with fibrous tissue and showed mainly cystic degenerative changes with some solid portions. Histologically, the solid portions were composed of uniform cells forming solid and pseudopapillary structures with many PAS-positive granules. Immunohistochemical staining for α₁-antitrypsin showed a granular distribution. Electron microscopic examina-tion showed that the tumor cells had many zymogen like granules. Many of 126 SCT cases in Japan usually develop in relatively young women, and show a favorable prognosis if treated surgically. Only three dead cases with liver metastasis, peritonitis carcinomatosa and metastasis to multiple organs were reported. Histologically, the tumor cells do not always have α₁-antitrypsin and zymogen like granules and SCT might originate from primodial cells. In our case, it was supposed that the tumor cells showed differentiation to acinar cells of the pancreas.