Mucinous cystadenocarcinoma presented with acute pancreatitis and marked variation of serum levels of CEA and CA19-9

Abstract

A 56-year-old woman was admitted with a sudden onset of left abdominal pain. Laboratory data showed inflammatory reactions and a marked increase in serum concentrations of CEA (240ng/ml) and CA19-9 (200,867U/ml), which showed enormous variation thereafter. A computed tomography scan revealed a cystic lesion, 13cm in diameter, in the pancreatic tail, a 7cm-sized cystic lesion in the retroperitoneal space, and pleural effusion on the left side. Although the retroperitoneal cystic lesion thought to be a pseudocyst gradually shrank, the cyst in the pancreatic tail showed no change in size. We performed distal pancreatectomy under the preoperative diagnosis of mucinous cystic neoplasm. The resected specimen showed a 15cm-sized multilocular cyst with a smooth inner surface and a fibrous capsule. The cyst contains brownish-red mucin and haemorrhagic-necrotic material. Histological findings revealed the large cystic lesion was lined by columnar epithelium showing severe dysplasia with multifocal stromal invasion, and ovarian-type stroma positive for estrogen and progesterone receptors was evident. Thus, the final diagnosis was mucinous cystadenocarcinoma. Mucinous cystadenocarcinoma may be presented with acute pancreatitis and marked variation of serum tumor markers.