CYSTADENOMA OF THE PANCREAS DEMONSTRATED BY COMPUTED TOMOGRAPHY WITH THE ACTA-SCANNER-A CASE REPORT DAVID V. MARAIST
and PAUL J. SIBILLE
Department of Radiology, Our Lady of Lourdes Hospital, Lafayette. LA 70501, U.S.A (Receiard
16 August
1976)
Abstract-A case of pancreatic cystadenoma demonstrated by computed tomography of the abdomen with the ACTA-Scanner is described. CT scanning of the abdomen holds great potential in the evaluation of pancreatic enlargements as well as other abdominal tumors. Pancreas
Cystadenoma
Computed tomography
Abdomen
INTRODUCTION
Neoplasms of the pancreas have long posed a diagnostic enigma to the radiologist. Even though the pancreas is a central retroperitoneal organ in close contact with many intra-abdominal structures, the roentgen diagnosis of pancreatic neoplasm is often difficult to make [l]. Abnormal signs of contrast studies of the gastrointestinal tract are often present only after the disease has progressed beyond its early stages. Likewise, pancreatic scanning has proven extremely unreliable due to the variation in uptake and the high background counts in the adjacent liver and intestine [a]. The advent of computed tomography(CT) has aroused the hopes of radiolgoists that this new diagnostic tool may prove valuable in detecting pancreatic tumors. The following case report with illustrations shows that these hopes may be well founded.
CASE
REPORT
A 57-yr-old white woman was admitted on 17 August, 1975 complaining of recurring abdominal pains and dyspepsia. Her physical examination was normal. An oral cholecystogram demonstrated a single lucent gallstone measuring 8 mm in dia., and an upper gastrointestinal series was normal except for a small hiatus hernia. The duodenum showed no radiographic abnormality (Fig. 1). It was incidentally noted that there was a deposit of calcification in the right upper quadrant of the abdomen which was not definitely localized (Fig. 2). At cholecystectomy, a large (fist-sized) mass was palpated in the head of the pancreas. This mass was dissected free and found to be very firm and hard. The surgeon thought this mass was carcinoma and performed a transduodenal needle biopsy, which was submitted to the pathologist for frozen section examination. The diagnosis rendered was papillary cystadenoma of the pancreas with no evidence of malignancy. The abdomen was closed without removing the benign neoplasm, and the patient’s recovery from surgery was uneventful. One month after surgery, the patient underwent a CT examination of the abdomen. This revealed a mass arising from the posterior--medial aspect of the head of the pancreas measuring approx. 8 cm in diameter. The abnormality was best appreciated on the section taken 6 cm below the xiphoid process. The lesion was of relatively lower absorption than the remainder of the pancreas and contained a central focus of very high absorption indicating a calcific nidus. This location on the scan corresponded to the calcific deposit noted at time of excretory urography. 121
122
DAVIDV. MARAISTand PAUL J. GRILLE
DISCUSSION The cystadenoma is a rare but distinctive benign neoplasm which arises from pancreatic ducts and occurs predominantly in females during the fourth to sixth decades [3,4]. It is felt by the authors that this diagnostic mode has great potential in the evaluation of enlargements of the pancreas. Oral contrast media (barium sulfate or iodinated contrast) are useful in differentiating the pancreas from the adjacent stomach and intestine on the CT scan. Other abdominal tumors, especially retroperitoneal neoplasm, may also be demonstrated by CT scanning. Acknowledgement-The authors would like to express their thanks to Dr. ELMOJ. LABORDEand Dr. TUNEY ARCENEAUX for the surgical data.
REFERENCES 1. W. J. Dodd and F. F. Zboralske, Roentgenographic diagnosis of pancreatic neoplasms. Semin. RoentgenoL 3, 242-253 (1968). 2. X. J. Riccobono, Pancreatic scanning. Semin. RoentgenoL 3, 31C-317 (1968). 3. H. J. Spjut and M. S. Anderson, Pathology of the pancreas. Semin. Roentgenol. 3, 217-226 (1968). 119, I1 5-120 4. B. D. Pressman. T. Asch. W. J. Casarella, Cystadenoma of the pancreas. Am. J. Roentgend (1973). About the Author-DAVID VICTORMARAISTwas born 21 October, 1940, in New Iberia. LA. He was educated at the University of Notre Dame, University of Southwestern Louisiana, and University of Vienna and received the M.D. degree from the Louisiana State University School of Medicine in 1965. Dr. Maraist is board certified in radiology and nuclear medicine. He is presently Chief of Radiology, Our Lady of Lourdes Hospital in Lafayette, Louisiana, and is a member of the American College of Radiology, Radiological Society of North America, Alpha Omega Alpha Honor Medical Society, and the American College of Nuclear Medicine. About the Author--PAUL J. SIBILLEwas born 26 April, 1941, in Lafayette, LA. He attended the University of Southwestern Louisiana and received the M.D. degree from Louisiana State University School of Medicine in 1965. Dr. Sibille is board certified in radiology and nuclear medicine. He is presently serving as radiologist at Our Lady of Lourdes Hospital in Lafayette, Louisiana and is a member of the American College of Radiology, the Radiologic Society of North America, and the American College of Nuclear Medicine.
123
Fig. 1. Film from upper gastrointestinal series showing a normal duodenum. Fig. 2. The black arrow indicates calcification in the right upper quadrant which is crescent shaped.
124
Fig. 3. c:01 mput ed tomogram of abdomen at 6 cm below xiphoid process sheJwing mass head of Pimere :as with central calcification, Other structures well delineate :d inc lude 1 kid neys, tip of spleen, right lobe of liver, vertebral body and sort a. Fig. 4. EJnllargernent of Fig. 3 with reversal of image orientation (cyst is now on letI side of film) . Gr ‘ea.ter dletail of the tumor is noted with the mass showing relatively lower phot on abso rptic m than the remainder of the pancreas which is curved around the mas #slater .ally a nd anteriorly.
and PAUL J. SIBILLE
Department of Radiology, Our Lady of Lourdes Hospital, Lafayette. LA 70501, U.S.A (Receiard
16 August
1976)
Abstract-A case of pancreatic cystadenoma demonstrated by computed tomography of the abdomen with the ACTA-Scanner is described. CT scanning of the abdomen holds great potential in the evaluation of pancreatic enlargements as well as other abdominal tumors. Pancreas
Cystadenoma
Computed tomography
Abdomen
INTRODUCTION
Neoplasms of the pancreas have long posed a diagnostic enigma to the radiologist. Even though the pancreas is a central retroperitoneal organ in close contact with many intra-abdominal structures, the roentgen diagnosis of pancreatic neoplasm is often difficult to make [l]. Abnormal signs of contrast studies of the gastrointestinal tract are often present only after the disease has progressed beyond its early stages. Likewise, pancreatic scanning has proven extremely unreliable due to the variation in uptake and the high background counts in the adjacent liver and intestine [a]. The advent of computed tomography(CT) has aroused the hopes of radiolgoists that this new diagnostic tool may prove valuable in detecting pancreatic tumors. The following case report with illustrations shows that these hopes may be well founded.
CASE
REPORT
A 57-yr-old white woman was admitted on 17 August, 1975 complaining of recurring abdominal pains and dyspepsia. Her physical examination was normal. An oral cholecystogram demonstrated a single lucent gallstone measuring 8 mm in dia., and an upper gastrointestinal series was normal except for a small hiatus hernia. The duodenum showed no radiographic abnormality (Fig. 1). It was incidentally noted that there was a deposit of calcification in the right upper quadrant of the abdomen which was not definitely localized (Fig. 2). At cholecystectomy, a large (fist-sized) mass was palpated in the head of the pancreas. This mass was dissected free and found to be very firm and hard. The surgeon thought this mass was carcinoma and performed a transduodenal needle biopsy, which was submitted to the pathologist for frozen section examination. The diagnosis rendered was papillary cystadenoma of the pancreas with no evidence of malignancy. The abdomen was closed without removing the benign neoplasm, and the patient’s recovery from surgery was uneventful. One month after surgery, the patient underwent a CT examination of the abdomen. This revealed a mass arising from the posterior--medial aspect of the head of the pancreas measuring approx. 8 cm in diameter. The abnormality was best appreciated on the section taken 6 cm below the xiphoid process. The lesion was of relatively lower absorption than the remainder of the pancreas and contained a central focus of very high absorption indicating a calcific nidus. This location on the scan corresponded to the calcific deposit noted at time of excretory urography. 121
122
DAVIDV. MARAISTand PAUL J. GRILLE
DISCUSSION The cystadenoma is a rare but distinctive benign neoplasm which arises from pancreatic ducts and occurs predominantly in females during the fourth to sixth decades [3,4]. It is felt by the authors that this diagnostic mode has great potential in the evaluation of enlargements of the pancreas. Oral contrast media (barium sulfate or iodinated contrast) are useful in differentiating the pancreas from the adjacent stomach and intestine on the CT scan. Other abdominal tumors, especially retroperitoneal neoplasm, may also be demonstrated by CT scanning. Acknowledgement-The authors would like to express their thanks to Dr. ELMOJ. LABORDEand Dr. TUNEY ARCENEAUX for the surgical data.
REFERENCES 1. W. J. Dodd and F. F. Zboralske, Roentgenographic diagnosis of pancreatic neoplasms. Semin. RoentgenoL 3, 242-253 (1968). 2. X. J. Riccobono, Pancreatic scanning. Semin. RoentgenoL 3, 31C-317 (1968). 3. H. J. Spjut and M. S. Anderson, Pathology of the pancreas. Semin. Roentgenol. 3, 217-226 (1968). 119, I1 5-120 4. B. D. Pressman. T. Asch. W. J. Casarella, Cystadenoma of the pancreas. Am. J. Roentgend (1973). About the Author-DAVID VICTORMARAISTwas born 21 October, 1940, in New Iberia. LA. He was educated at the University of Notre Dame, University of Southwestern Louisiana, and University of Vienna and received the M.D. degree from the Louisiana State University School of Medicine in 1965. Dr. Maraist is board certified in radiology and nuclear medicine. He is presently Chief of Radiology, Our Lady of Lourdes Hospital in Lafayette, Louisiana, and is a member of the American College of Radiology, Radiological Society of North America, Alpha Omega Alpha Honor Medical Society, and the American College of Nuclear Medicine. About the Author--PAUL J. SIBILLEwas born 26 April, 1941, in Lafayette, LA. He attended the University of Southwestern Louisiana and received the M.D. degree from Louisiana State University School of Medicine in 1965. Dr. Sibille is board certified in radiology and nuclear medicine. He is presently serving as radiologist at Our Lady of Lourdes Hospital in Lafayette, Louisiana and is a member of the American College of Radiology, the Radiologic Society of North America, and the American College of Nuclear Medicine.
123
Fig. 1. Film from upper gastrointestinal series showing a normal duodenum. Fig. 2. The black arrow indicates calcification in the right upper quadrant which is crescent shaped.
124
Fig. 3. c:01 mput ed tomogram of abdomen at 6 cm below xiphoid process sheJwing mass head of Pimere :as with central calcification, Other structures well delineate :d inc lude 1 kid neys, tip of spleen, right lobe of liver, vertebral body and sort a. Fig. 4. EJnllargernent of Fig. 3 with reversal of image orientation (cyst is now on letI side of film) . Gr ‘ea.ter dletail of the tumor is noted with the mass showing relatively lower phot on abso rptic m than the remainder of the pancreas which is curved around the mas #slater .ally a nd anteriorly.
