Unraveling Abdominal Distention: A Rare Presentation of Giant Pancreatic Mucinous Cystic Neoplasm in a Patient With Cystic Fibrosis
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".