Abstract
A 61-year-old woman with a 40 mm cystic lesion of the pancreatic body was kept under observation by a local physician. When follow-up imaging showed enlargement of the tumor, she was subsequently referred to our institution. We investigated by CT and discovered the tumor had grown to 130 mm. The same CT also revealed a small amount of blood accumulated in the Douglas pouch (recto-uterine pouch). We diagnosed the condition as ruptured mucinous cystoadenocarcinoma (MCC) of the pancreatic body with intra-abdominal bleeding and we opted to surgically remove the tumor. Intra-operatively, we visually confirmed the blood accumulation in the Douglas pouch. We also observed whitish nodules surrounding the tumor suggesting peritoneal dissemination. We resected the tumor en-bloc to halt the abdominal hemorrhaging. The resected organs were: the pancreatic tail and body, the spleen, the stomach, the left hepatic lobe, and part of the transverse colon. The pathology report confirmed the diagnosis of anaplastic carcinoma derived from mucinous cystadenocarcinoma with ovarian-like stroma. The whitish nodules were also confirmed as peritoneal dissemination. Her postoperative recovery was uneventful and the patient was discharged three weeks after the operation. However, liver metastasis and peritoneal dissemination advanced rapidly and the patient passed away 3 months after surgery. Previously, only two cases of ruptured MCC were reported in Japan; this case marks the third.
