Abstract
A 44-year-old woman with sudden-onset severe abdominal pain was brought to our hospital by ambulance. Computed tomography (CT) scan showed coupled cystic lesions presenting as a 70 mm unilocular cystic lesion in the pancreatic tail, and a 95 mm unilocular cystic lesion in the stomach wall. Endoscopic ultrasound showed a unilocular anechoic cystic lesion with a thick wall in the pancreatic tail, which communicated with a multilocular cystic lesion in the stomach wall. Fine needle aspiration identified bloody fluid in the stomach cyst. Amylase and carcinoembryonic antigen (CEA) levels were elevated in the fluid. We diagnosed mucinous cystic neoplasm of the pancreatic tail perforating into the stomach wall with hemorrhage. Distal pancreatectomy with resection of the cystic lesion in the stomach wall was performed. The histopathological diagnosis was mucinous cyst adenoma of the pancreas with ovarian-like stroma. Analysis of the fluid showed that the amylase level was high in both lesions, suggesting that the mucinous cyst adenoma had communicated with the pancreatic duct and enlarged, before perforating the stomach wall.
