Case 16


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.



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).


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

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