Unraveling Abdominal Distention: A Rare Presentation of Giant Pancreatic Mucinous Cystic Neoplasm in a Patient With Cystic Fibrosis
Notice bibliographique
Résumé
CASE REPORT Patients with cystic fibrosis (CF) exhibit diverse pancreatic disorders, encompassing functional insufficiency, structural abnormalities (fibrofatty parenchymal replacement, pancreatic cysts), and endocrine/exocrine dysfunction.1 In this study, we present a case of pancreatic mucinous cystic neoplasm in a patient with CF, recognized as a premalignant lesion for pancreatic adenocarcinoma. A 22-year-old woman with CF with genetic mutations F508del/G551D on elexacaftor/tezacaftor/ivacaftor and exocrine pancreatic insufficiency on pancreatic enzyme replacement therapy presented with abdominal distention. Computed tomography imaging revealed a large cystic lesion with mildly enhancing internal septations anterior to the left kidney between the stomach and the spleen, measuring 14.5 × 15.5 × 18 cm (Figure 1). After a multidisciplinary team consultation and discussion, the patient underwent surgery, with excision of a 15-pound cystic mass from the pancreas along with distal pancreatectomy (Figure 2). Histopathological analysis identified a mucinous cystic neoplasm of the pancreas with multifocal low-grade and high-grade dysplasia and intestinal metaplasia (Figures 3 and 4). A systematic review has shown that patients with CF demonstrate an increased risk of gastrointestinal malignancies.2,3 Cystic lesions of the pancreas in CF, although rare, need close follow-up due to the potential risk of malignancy. With increased lifespan due to cystic fibrosis transmembrane conductance regulator modulator drugs, and transplantation, vigilance for premalignant lesions, especially pancreatic cancers, is crucial.Figure 1.: Computed tomography of the abdomen/pelvis image with arrow pointing to a cystic lesion with mildly enhancing internal septations, measuring 18 cm in the coronal plane, between the stomach and the spleen, and displacing bowel loops to the right.Figure 2.: Intraoperative picture of the surgically excised mass from the pancreas (100×).Figure 3.: High-power microscopic view of the excised mass showing the classical histopathology of mucinous cystic neoplasm. The black arrow points toward the mucinous epithelium seen as columnar cells with pale pink apical mucin. The star points to the spindled, dense “ovarian-type” stroma (200×).Figure 4.: High-power microscopic view of the same specimen with black arrows pointing to cells with elongated, penicillate, and pseudostratified nuclei (low-grade dysplasia) and scattered goblet cells, indicating areas of intestinal metaplasia (200×).DISCLOSURES Author contributions: G. Nageswaran, L. Ton, VT Chandrasekar, JEL Yap made substantial contributions to the conception or design of the work; the acquisition, analysis, and interpretation of data for the work; drafting the work and critically reviewing it for important intellectual content, and gave final approval for the work to be published. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. JEL Yap is the article guarantor. Financial disclosure: None to report. Previous presentation: Abstract accepted and presented as a poster in the American College of Gastroenterology Annual Meeting held in Vancouver, Canada between October 20–25, 2023. Informed consent was obtained for this case report.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».