16

Case 16


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.


Physical examination


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).






images


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);


Oct 23, 2019 | Posted by in GASTROENTEROLOGY | Comments Off on 16
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