Challenge in differentiation of pancreatic cystic neoplasms between intraductal papillary mucinous neoplasm and mucinous cystic neoplasm: A case report

Abstract

Incidental pancreatic cystic neoplasms (PCNs) are frequently detected as a result of advances in imaging technologies nowadays. Cystic lesions with higher malignant potential include mucinous neoplasms, such as intraductal papillary mucinous neoplasm (IPMN) and mucinous cystic neoplasm (MCN). There are crucial differences between MCN and IPMN in their biological behavior and clinical prognosis. However, currently available tools are imperfect to differentiate between IPMN and MCN. We reported a case of a 46‐year‐old woman with incidental pancreatic tail cyst of 8 cm size. Computed tomography scan and endoscopic ultrasound with fine‐needle aspiration showed a tumor located at the pancreatic tail. The macrocystic lesion had septa and peripheral calcification, and cystic fluid analysis revealed high level of carcinoembryonic antigen (CEA) with low level of amylase. These clinical features are suggestive of MCN in previous experience. Patient underwent laparoscopic distal partial pancreatectomy and splenectomy. The final pathological result was IPMN. Following the application of updated 2017 consensus guideline and 2018 American College of Gastroenterology (ACG) guideline will provide more precise preoperative evaluation and postoperative surveillance. We try to explain the discrepancy between the diagnostic modalities, and more cost‐effective, validated biomarkers are required for differentiating PCNs in the future.