A 25-year-old female patient presented with uncharacteristic upper abdominal pain. A CT-scan was done in summer 2007. It showed a cyst of about 10 mm inside the pancreatic tail.
A CT-control-scan 6 months later showed that the cyst had grown to 22 cm. In MRCP and MRT of the abdomen and in upper abdomen sonography with echo enhancement the cyst could also be seen but no new information was gained.
The endosonography showed several structures inside the cyst. The cytology only showed degenerative ductal epithelia without signs of malignancy and without a good reason for the cyst formation.
The patient was finally convinced to agree to an operation. A spleen conserving resection of the left pancreas was performed.
Histologically there were inclusions of a unilocated and mucinous cystic neoplasia with low grade dysplasia and accompanying chronic fibrosing pancreatitis and also focal pancreatic intraepethilial neoplasia (PAN IN 1a), the resection was done inside healthy tissue.
The patient has seens been free of complaints.
Incidentalomas are per definition incidental findings of modern high definition imaging techniques. In the literature 30 % of pancreatic incidentalomas are malign and up to 50 % show pre-malign leasons. Patients with low operating risk and without comorbidities should undergo resection early on, especially if the leason is bigger than 20 mm.
The presented case also showed, histologically, a focal intraepithelial neoplasia.
The name "incidentaloma" can create a false sense of security and a biding of time in treatment and attitude of patient and doctor and therefore should be avoided.Source: Ultraschall im Netz
