History
A 52-year-old lady with a past history of thyroiditis presents with a 6-month history of left lower abdominal pain. There are no constitutional symptoms, change in bowel habit, or rectal bleeding. She is a non-drinker.
•Afebrile, pulse 80 bpm, BP 120/80mmHg, SaO2 98-100% on RA.
•Hydration is satisfactory.
•Examination of the hands reveals no clubbing and normal-appearing palmar creases.
•Head and neck examination is unremarkable.
•Cardiovascular: HS dual, no murmur.
•Her chest is clear on auscultation.
•Abdominal examination reveals a soft, non-tender abdomen, with no peritoneal signs.
•No signs of oedema.
Investigations
•CBC:
–WBC 4.7 x 109/L;
–haemoglobin 12g/dL;
–platelets 177 x 109/L.
A computed tomography scan of her abdomen is performed (Figure 16.1).
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Please describe what you see
There is a cystic lesion with rim enhancement at the tail of the pancreas.
What is your differential diagnosis?
•Non-neoplastic lesion:
–pseudocyst (accounts for up to 30% of all pancreatic cystic lesions, up to 50% in patients with a history of pancreatitis);
–true cyst;
–retention cyst;
–lymphoepithelial cyst;
–mucinous non-neoplastic cyst.
•Neoplastic lesion (accounting for ~10-15% of pancreatic cysts):
–serous cystic neoplasm (SCN);
–mucinous cystic neoplasm (MCN);
–intraductal papillary mucinous neoplasm (IPMN):
■main duct;
■branch duct;
–solid pseudopapillary tumour (SPT);
–cystic pancreatic neuroendocrine tumour (NET);
–
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