Mucinous cystic neoplasm pancreas with carcinoma pancreas invading spleen and mucinous cystadenomas both ovaries: a case report and review of literature

A 37-year-old lady presented with a recurrent cystic lump in left hypochondrial region. It was initially thought to be of renal origin and marsupialized. Recurrence of the lesion after three years prompted a repeated surgery in the form of a sub-total excision wherein the “renal cyst” was noted to be densely adherent to the tail of the pancreas. The histopathology was reported as a “benign intestinal duplication cyst”. During post-operative period a collection was noted in left hypochondrial region, which was drained under ultrasound guidance. Further serial sonograms revealed progressive increase in its size as well as appearance of cysts in the ovaries; first in the left and then in the right ovary. Follow up CT Scan revealed a cystic lesion in the spleen with extra splenic extension into the tail of the pancreas. Large thin walled cysts were noted in both ovaries. Tumour markers like CA 125, CEA, AFP and BHCG were all within normal limits. The huge cystic masses of both ovaries and the spleen were distending the abdomen. She was taken up for exploratory Laparotomy and a Total Abdominal Hysterectomy with Bilateral Salpingoophorectomy, with Splenectomy and Distal Pancreatectomy was done. Her post-operative recovery was uneventful. Final histopathology examination revealed a Mucinous Cystic Neoplasm Pancreas with a Well Differentiated Adenocarcinoma Pancreas with extra Pancreatic Extension involving Spleen and Bilateral Ovarian Mucinous Cystadenomas. The rare lesion was difficult to label accurately because of its nebulous connection and origin from the tail of the pancreas. Once excised completely and accurately labelled she has been offered adjuvant chemotherapy which she is continuing, despite a stormy first pulse, which was complicated by a recurrence of collection in left hypochondrial region causing features of sub-acute intestinal obstruction, but managed successfully with ultrasound guided pig tail drainage. In view of propensity of metastases from pancreas to simulate primary mucinous tumours of the ovary a close watch is being maintained while continuing adjuvant chemotherapy.