A Case of Serous Cystadenoma of the Pancreas with Obstructive Jaundice and Severe Adhesion to the Portal Vein

Yoshiharu Shirakata, Mami Yoshitomi, Koji Ikebukuro, Hisashi Sawada, Kazumi Itoi, Manabu Fukuyama, Hidefumi Nishikawa, Yoshifumi Mizuno and Yoshihiko Makino

Department of Surgery, Hyogo Prefectural Amagasaki Hospital

A 68-year-old woman with abdominal pain and dark urine consulted a local practitioner. She was referred to our hospital for further examination with the possible diagnosis of pancreatic tumor and obstructive jaundice. Abdominal enhanced computed tomography (CT) showed a heterogeneous tumor measuring 4.0 cm in its maximum diameter at the head of the pancreas and a neighboring cystic tumor adjacent to the portal vein. Cholangiography showed the complete obstruction of the common bile duct at the end. Angiography showed a marked tumor stain and a 4.0 cm-long stenosis of the portal vein. An operation was performed because malignancy could not be ruled out. We noticed an elastic hard tumor measuring 4.0 cm in diameter at the head of the pancreas and a neighboring tumor measuring 3.0 cm in diameter protruding from the pancreas toward the liver with severe adhesion to the portal vein. We could not detach the tumor from the portal vein and performed pancreatoduodenectomy with a concomitant segmental excision of 4.0 cm of the portal vein, followed by reconstruction. The histological diagnosis was serous cystadenoma of the pancreas and there was no evidence of malignancy. The postoperative course was excellent. Previously, serous cystadenoma of the pancreas was considered to be a benign tumor and this is an extremely rare case because concomitant excision of the portal vein was necessary for the resection of this tumor, in addition to its morphological specificity.

Key words
obstructive jaundice, severe adhesion to the portal vein, serous cystadenoma of the pancreas

Reprint requests
Yoshiharu Shirakata Department of Surgery, Hyogo Prefectural Amagasaki Hospital
1-1-1 Higashidaimotsu-cho, Amagasaki, 660-0828 JAPAN

Accepted
July 23, 2003

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