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Cystadenoma of the Pancreas: Its Arteriographie Diagnosis

1963; Radiological Society of North America; Volume: 80; Issue: 5 Linguagem: Inglês

10.1148/80.5.776

1527-1315

William P. Bieber, Robert J. Albo,

Pancreatic and Hepatic Oncology Research

Selective arteriography and aortography have been utilized in the demonstration of neoplasms of nearly all the abdominal organs, most extensively in connection with renal and perirenal tumors. It is the purpose of this report to describe a case of cystadenoma of the pancreas and its radiographic appearance. Case Report A 53-year-old male was admitted to San Francisco General Hospital because of jaundice, acholic stools, and dark urine of two weeks duration. He had no history of abdominal surgery or of gallbladder disease, but for one and one-half years prior to this illness he had been aware of the presence of a moderately tender epigastric mass. In the three months before admission both the size of the mass and the degree of tenderness increased. Appetite and weight remained stable. On physical examination, the patient was obviously jaundiced. The abdomen was moderately distended and a fixed mass, 10 × 10 cm., was palpated in the mid epigastrium. The mass was pulsatile and a systolic bruit was heard on auscultation. Laboratory findings were: total bilirubin 12.0, with a direct fraction of 7.9 mg. per cent; fasting glucose 100 mg. per cent; alkaline phosphatase 12.0 Kings-Armstrong units; prothrombin time 10 per cent; blood-urea-nitrogen 6 mg. per cent; blood counts normal. An upper gastrointestinal series demonstrated a large mass in the region of the head of the pancreas. A translumbar aortogram revealed a large vascular tumor in the same area. At surgery a 10-cm. encapsulated tumor was found occupying the head and body of the pancreas. Large dilated veins covered the surface, and the gastroduodenal artery supplying the tumor bed was enlarged to 0.8 cm. The gallbladder and bile ducts were markedly dilated. No metastases were observed. A pancreaticoduodenectomy block resection and re-anastomosis were performed. The cut surface of the tumor showed multiple small cystic spaces (Fig. 3, upper right). Microscopic examination was consistent with benign cystadenoma of the pancreas. Roentgenographic Findings: The upper gastrointestinal examination demonstrated displacement of the distal stomach and marked widening of the duodenal loop. The mucosa of the stomach and duodenum were without evidence of tumor invasion (Fig. 1). The translumbar aortogram showed the abdominal aorta with its celiac, superior mesenteric, and renal artery branches (Fig. 2, A). The portion of the aorta adjacent to the tumor was bowed to the left. The gastroduodenal artery branch of the celiac group (upper arrow), along with the inferior pancreaticoduodenal branch of the superior mesenteric artery (lower arrow), supplied the tumor bed and could be seen stretched around its margin. The right renal artery was superimposed but at surgery was not found to be involved. The film obtained six seconds after injection demonstrated a marked homogeneous vascular blush outlining the tumor bed (Fig. 2, B).