Mature cystic teratoma of the pancreas: Role of endoscopic ultrasound

The Utility of Fine Needle Aspiration (FNA) Biopsy in the Diagnosis of Mediastinal Lesions

Fine needle aspiration is a minimally invasive, low-morbidity, and cost-efficient technique for the sampling of mediastinal lesions. Additionally, ancillary testing on FNA samples can be used for the refinement of diagnoses and for treatment-related purposes (flow cytometry, cytogenetics, immunohistochemistry, and molecular diagnostics). Mediastinal lesions, however, can show a variety of lineages and morphologic features, giving rise to diagnostic dilemmas. As a result, the differential diagnosis can vary widely and becomes especially challenging due to the smaller sample size on FNA and the variability in component sampling. For appropriate patient management and to determine the correct treatment strategies, accurate pathologic diagnoses are paramount. In this review, we present the cytomorphologic features together with the immunophenotypic findings of mediastinal lesions, with emphasis on the diagnostic challenges and pitfalls in FNA cytology samples, including smears and cell block sections.

Neuroendocrine Tumor Arising within Mature Cystic Teratoma of the Pancreas: Literature Review and Case Report

Cystic teratomas are germ cell tumors most commonly found in the ovaries and testes. The pancreas, however, is very rare as a site of occurrence. Moreover, only two cases of cystic teratoma with concomitant neuroendocrine tumor have been reported to date. We report the case of a 33-year-old female who presented with abdominal pain. Computed tomography and magnetic resonance imaging of the upper abdomen revealed an 85 mm cystic tumor in the head of the pancreas. Cystic teratoma and mucinous cystadenoma were suggested as differential diagnoses. Cytopathologic analysis of endoscopic ultrasound-guided fine needle aspiration was consistent with mucinous cystadenoma. Therefore, the patient underwent surgical resection. Histologic analysis revealed a mature cystic teratoma of the pancreas with a concomitant neuroendocrine tumor. The patient is in great condition at 8 months follow-up. Cystic teratoma of the pancreas with a concomitant neuroendocrine tumor is an extremely rare condition. Surgical resection remains the mainstay of treatment as it provides a definitive diagnosis and no recurrences have been reported to date.

Diagnosis and differentiation of mature cystic teratoma of pancreas from its mimics: A case report

INTRODUCTION

Mature cystic teratoma originating in the pancreas is very unusual, often observed as an incidental finding during routine examinations or recognized perioperatively as the patients present with very unspecific clinical symptoms. The confirmatory diagnosis of a pancreatic cystic teratoma is generally made by histopathology after surgical excision. So, the preoperative diagnosis is very challenging, especially differentiation from the other pancreatic pathologies.

PATIENT CONCERNS

A 23-year-old woman was admitted to our hospital with a complaint of mild grade periumbilical abdominal pain. A pancreatic mass was revealed on a preliminary abdominal ultrasound examination. Her medical history was unremarkable with no long-standing illness or malignancy.

DIAGNOSIS

Mature cystic teratoma in the head of the pancreas.

INTERVENTIONS

Roux-enY choledochojejunostomy with gastrojejunostomy was performed, excising the tumor from the pancreatic head.

OUTCOMES

The postoperative course was uneventful; the patient was asymptomatic and has no evidence of recurrence on a 2-year follow up.

CONCLUSIONS

Pancreatic cystic teratoma is a benign, well-differentiated, and extremely rare congenital tumor. MRI is the choice of imaging modality and phase-GRE or fat suppression is the best technique for pre-operative diagnosis.

Mature Cystic Teratoma of the Pancreas: A Rare Cystic Neoplasm

Mature cystic teratoma of the pancreas is an extremely rare benign neoplasm. Only 51 cases have been reported in the literature. Its cystic nature often appears to have malignant potential in preoperative image studies. Moreover, no characteristic features could be shown on image studies, such as abdominal CT scan or pancreas MRI. The accurate diagnosis is generally obtained after surgical resection. We present a rare case of a 53-year-old male with mature cystic teratoma of the pancreas, which was confirmed on pathology after laparoscopic distal pancreatectomy.

Mature cystic teratoma of the pancreas with 30 years of clinical course: A case report

RATIONALE

Mature cystic teratoma of the pancreas is an extremely rare condition that is challenging to manage due to inadequate preoperative histological diagnosis.

PATIENT CONCERNS

A 36-year-old female was admitted to our hospital because of a complaint of worsening paroxysmal abdominal pain for over a year. She was diagnosed with pancreatic pseudocyst and underwent five surgical procedures (i.e., four external drainage and one internal drainage procedures) in the last 30 years.

DIAGNOSES

Intraoperative frozen section analysis identified the tumor as a cystic teratoma, and pathological evaluation confirmed it to be a mature cystic teratoma.

INTERVENTIONS

Explorative laparotomy was performed, and the tumor was then resected completely through with partial pancreatectomy, left colon resection, partial gastrectomy, duodenectomy, as well as inferior vena cava and renal vascular repair.

OUTCOMES

The patient exhibited a generally good wellbeing without any recurrence during the 6 months of follow up.

LESSONS

This case demonstrated the significant impacts of misdiagnosis and inappropriate treatments for benign disease on the patient's quality of life and highlighted the importance of early surgical resection with a definitive pathological diagnosis for pancreatic cystic teratoma.