Yan ZY, Shi W, Guo T, Yang AM. Mucinous cystic neoplasm mimicking pancreatic pseudocyst and progressing to adenocarcinoma: A case report. World J Gastrointest Oncol 2025; 17(5): 105417 [DOI: 10.4251/wjgo.v17.i5.105417]
Corresponding Author of This Article
Tao Guo, MD, Professor, Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing 100730, China. guoqiong990@126.com
Research Domain of This Article
Oncology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. May 15, 2025; 17(5): 105417 Published online May 15, 2025. doi: 10.4251/wjgo.v17.i5.105417
Mucinous cystic neoplasm mimicking pancreatic pseudocyst and progressing to adenocarcinoma: A case report
Zhi-Yu Yan, Wen Shi, Tao Guo, Ai-Ming Yang
Zhi-Yu Yan, Wen Shi, Tao Guo, Ai-Ming Yang, Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China
Zhi-Yu Yan, Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
Author contributions: Yan ZY, Shi W, and Guo T contributed to the study conceptualization; Guo T and Yang AM supervised the study; Yan ZY contributed to data collection and manuscript drafting; Shi W and Guo T contributed to manuscript revision; and all authors have approved the final manuscript.
Supported by the National Key Research and Development Program of China, ‘Clinical Performance Verification of Radial Ultrasound Endoscope’, No. 2017YFC0109804; and the National High Level Hospital Clinical Research Funding, No. 2022-PUMCH-A-076.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tao Guo, MD, Professor, Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing 100730, China. guoqiong990@126.com
Received: January 27, 2025 Revised: March 22, 2025 Accepted: April 22, 2025 Published online: May 15, 2025 Processing time: 110 Days and 20.3 Hours
Abstract
BACKGROUND
As a heterogeneous group of lesions, pancreatic cystic lesions (PCLs) vary enormously in malignant potential, mandating different treatment strategies. Despite significant advances in diagnostic imaging and laboratory tests, the accurate diagnosis of PCLs remains challenging, leading to overtreatment or delayed/missed surgical timing in patients with PCLs.
CASE SUMMARY
We present a case of a 64-year-old female patient in whom an asymptomatic, incidental cystic mass was found in the pancreatic tail on a routine abdominal ultrasound. After a comprehensive work-up with laboratory examinations, contrast-enhanced computed tomography, magnetic resonance imaging, and magnetic resonance cholangiopancreatography, a pancreatic pseudocyst was suspected. Subsequent endoscopic ultrasound with fine-needle aspiration and needle-based confocal laser endomicroscopy supported a benign diagnosis. Follow-up computed tomography and magnetic resonance imaging examinations five months later showed significant cyst shrinkage without any abnormalities. However, three years after being lost to follow-up, the patient was readmitted and diagnosed with pancreatic adenocarcinoma with multiple metastases, suggesting that the initial lesion was a mucinous cystic neoplasm misdiagnosed as a pancreatic pseudocyst.
CONCLUSION
Comprehensive integration of all available information (e.g., cyst features, abnormal imaging findings, cyst biochemistry, clinical history, and patient demographics) rather than over-reliance on imaging or endoscopic findings is pivotal to diagnosing PCLs, and patients with concerning features should undergo strict surveillance.
Core Tip: Advances in imaging are resulting in more incidental diagnoses of pancreatic cystic lesions. However, they can be challenging to subclassify, and their malignant potential varies, requiring different treatment approaches. Endoscopic ultrasound and ancillary methods like fine-needle aspiration and needle-based confocal laser endomicroscopy are significantly improving the sensitivity and accuracy of diagnosis. However, in this case, all these methods failed to identify subsequent malignant transformation, emphasizing the importance of attention to detail and strict and close surveillance where clinical uncertainty exists.
