Voluminous Pancreatic Mucinous Cystadenoma in a Non-Pregnant Woman with Rheumatoid Arthritis

This Article


Creative Commons License
Except where otherwise noted, this work is licensed under Creative Commons Attribution-NonCommercial 4.0 International License.

Article Information:

Group: 2011
Subgroup: Volume 13, Issue 8, Aug
Date: August 2011
Type: Letter to Editor
Start Page: 595
End Page: 596


  • SR Modarres
  • Department of Surgery, Bobol University of Medical Sciences, Babol, Iran
  • S Siadati
  • Department of Pathology, Bobol University of Medical Sciences, Babol, Iran
  • Z Momeni
  • Clinical Research Development Center, Shahid Beheshti Hospital, Babol, Iran


      Affiliation: Department of Pathology, Bobol University of Medical Sciences
      City, Province: Babol,
      Country: Iran
      Tel: +98-911-3232911
      Fax: +98-111-2266192
      E-mail: siadati_sepideh@yahoo.com

Manuscript Body:

Dear Editor,

Indeed, cystic tumors of the pancreas are rare and account for 10–15% of pancreatic neoplasms.1 There are four main categories of pancreatic cystic tumors including i) Mucinous cystic tumors (MCTs); ii) Serous cystic tumors (SCTs); iii) Intraductal papillary cystic tumors (IPCTs); and iv) Papillary cystic tumors.2,3 Mucinous cystic neoplasm of the pancreas is an uncommon tumor characterized by an inner mucin-producing columnar epithelium layer and an outer dense cellular ovarian-like stromal layer. These tumors are typically localized in the body and tail of the pancreas and do not communicate with the pancreatic ductal system.1,4 According to the studied reported so far, MCTs are found more commonly in females, especially in middle-aged more often than the elderly, and therefore are sex hormone- sensitive.3,4 Most of the large MCTs reported to date were in pregnant women and supposed to be due to over expression of sex hormones during this period.5-9 This is the first report of a huge MCT in a non-pregnant woman with rheumatoid arthritis having been under corticosteroids treatment. A 50-year-old woman was referred to Shahid Beheshti Hospital, Babol, Iran because of abdominal pain, distention and left abdominal mass. The patient was non-alcoholic with no history of gallbladder or pancreatitis. She had only a history of rheumatoid arthritis diagnosed at 42 years of age and had been under prednisolone (a corticosteroid) treatment. Physical examination suggested the presence of a mass in the left hypocondrium. Abdominal CT scan proved this finding. The patient underwent tumor resection with distal pancreatectomy due to the size and difficult handling of the tumor. A voluminous mass was found originating from the pancreatic body-tail (Figure 1). No evidence of invasive or metastatic tumor spread was observed within the abdomen. Pathological examination showed a 23×11×14 cm multilocular tumor, weighted 3065 g and pinkish gray. The cyst had a smooth internal surface filled with dark brown fluid. Microscopically, the cyst wall lined by mucin-producing columnar epithelium associated with an outer dense cellular ovarian-like stroma. The histological diagnosis was a mucinuos cystic neoplasm (musinous cystadenoma). The postoperative course was uneventful and the patient discharged 6 days after surgery in good general condition. After 6 months follow up, the patient was in good health and presented no signs of recurrence. However, the unusual size of the tumor was in contrast to the findings from other reports, since the patient was not pregnant with the cyst showing no sign of malignancy. Up to now, most of the large reported MCTs were in pregnant women and supposed to be due to over expression of sex hormones during this period.5-9 This is the first case of a huge MCT in a non-pregnant woman with rheumatoid arthritis having been under corticosteroids treatment. There is also another case reporting a large MCT in the appendix of a rheumatoid arthritis patient treated with steroids.10 To date, there is less done to identify the presence of various steroid receptors in MTNs. These studies indicate estrogen and progesterone receptors in the mass.11-13 Since the presence of other steroid receptors, especially glucocorticoid receptors has not been proven in MCTs, it is likely that prednisolone cause irregular mass overgrowth by interacting with its possible glucocorticoid receptors. In this regard, over expression of glucocorticoid receptors in human pancreatic cancer has been shown in one study.14 Therefore we suggest that steroids side effects, especially in patients with potentially malignant tumors, be investigated further.




Fig. 1: A huge cystic mass was found originating from body to tail of the pancreas.



Conflict of interest: None declared.

References: (14)

  1. Zamboni G, Scarpa A, Bogina G, Iacono C, Bassi C, Talamini G, Sessa F, Capella C, Solcia E, Rickaert F, Mariuzzi GM, Klöppel G. Mucinous cystic tumors of the pancreas: clinicopathological features, prognosis, and relationship to other mucinous cystic tu-mors. Am J Surg Pathol 1999;23:410-22. [10199470] [http://dx.doi.org/10.1097/00000478-199904000-00005]
  2. Salvia R, Festa L, Butturini G, Tonsi A, Sartori N, Biasutti C, Capelli P, Pederzoli P. Pancreatic cystic tumors. Minerva Chir 2004;59:185-207. [15238892]
  3. Dunitz M. Pancreatic cystic neoplasia. Health Sciences 2002; 1: 1-2.
  4. Thompson LD, Becker RC, Przygodzki RM, Adair CF, Heffess CS. Mucinous cystic neoplasm (mucinous cystadenocarcinoma of low-grade malignant potential) of the pancreas: a clinicopathologic study of 130 cases. Am J Surg Pathol 1999;23:1-16. [9888699] [http://dx.doi.org/10.1097/00000478-199901000-00001]
  5. Ikuta S, Aihara T, Yasui C, Iida H, Yanagi H, Mitsunobu M, Kakuno A, Yamanaka N. Large mucinous cystic neoplasm of the pancreas as-sociated with pregnancy. World J Gastroenterol 2008;21:14:7252-5. [19084943]
  6. Ishikawa K, Hirashita T, Kinoshita H, Kitano M, Matsuo S, Matsumata T, Kitano S. Large mucinous cystadenoma of the pancreas during pregnancy: report of a case. Surg Today 2007;37:1013-7. [17952538] [http://dx.doi.org/10.1007/s00595-007-3500-1]
  7. López-Tomassetti Fernández EM, Martín Malagón A, Arteaga Gonzalez I, Muñiz Montes JR, Díaz Luis H, González Hermoso F, Carrillo Pallares A. Mucinous cystic neoplasm of the pancreas during pregnancy: the importance of proper management. J Hepa-tobiliary Pancreat Surg 2005;12:494-7. [16365826] [http://dx.doi.org/10.1007/s00534-005-1005-0]
  8. Kato M, Kubota K, Kita J, Shimoda M, Rokkaku K, Inaba N, Fukasawa I, Honma K. Huge mucinous cystadenoma of the pancreas develop-ing during pregnancy: a case report. Pancreas 2005;30:186-8. [15714143] [http://dx.doi.org/10.1097/01.mpa.0000148512.92744.dc]
  9. Komatsu Y, Nonoyama M, Sekiguchi H, Suzuki N, Tagami K, Shibata H. A Case of Mucinous Cystadenoma of the Pancreas Developed during Pregnancy and Delivery. Japan J Gastroenterol Surg 2007;40:74-9.
  10. Sierra-Montenegro E, Sierra-Luzuriaga G, Leone-Stay G, Quinonez-Auria C, Salazar-Menendez V. Mucinous cystade-noma of the appendix. Case report. Cir Cir 2010;78:255-8. [20642910]
  11. Kushlinskii NE, Bogov RK, Patiutko Iu I, Liakina LT. Sex steroid hormones and their receptors in pancreatic neoplasms. Biull Eksp Biol Med 1998;126:197-200. [9777236] [http://dx.doi.org/10.1007/BF02446919]
  12. Yeh TS, Jan YY, Chiu CT, Ho YB, Chen TC, Lee KF, Chan KM, Hsu JC, Hwang TL, Chen MF. Characterisation of oestrogen receptor, progesterone receptor, trefoil factor 1, and epidermal growth factor and its receptor in pancreatic cystic neoplasms and pancreatic ductal adenocarcinoma. Gut 2002;51:712-6. [12377812] [http://dx.doi.org/10.1136/gut.51.5.712]
  13. Tanaka S, Kawamura T, Nakamura N, Teramoto K, Arii S. Mucinous cystadenocarcinoma of the pancreas developing during hor-mone replacement therapy. Dig Dis Sci 2007;52:1326-8. [17372823] [http://dx.doi.org/10.1007/s10620-006-9482-9]
  14. Bekasi S, Zalatnai A. Overexpression of glucocorticoid receptor in human pancreatic cancer and in xenografts. An immunohisto-chemical study. Pathol Oncol Res 2009;15:561-6. [19253003] [http://dx.doi.org/10.1007/s12253-009-9154-0]