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Abstract: This 65-year-old patient presented to the hospital with epigastric pain, which had also been present 1 year previously, but was not taken seriously. Recently, the symptoms of epigastric discomfort were aggravated, accompanied by nausea, diarrhea and nausea. After consultation, he was diagnosed with pancreatic plasma cystadenoma, a common type of cystadenoma, based on physical examination, symptoms and ancillary tests.
Basic information】Male, 65 years old
Disease Type】Plasmacytic cystadenoma of the pancreas
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of Consultation】January 2022
Treatment plan】Surgical treatment (pancreatic tumor enucleation) + oral medication (amoxicillin capsules)
Treatment period】2 weeks of hospitalization and regular follow-ups
Treatment effect] The patient’s abdominal discomfort disappeared, and no significant abnormality was found in the postoperative review of abdominal CT.
I. Initial consultation
Today, during the outpatient clinic, a patient came in with his stomach covered and complained of upper abdominal discomfort. After detailed inquiry, we learned that the patient, a retired worker, started to have vague discomfort in the upper abdomen with no obvious cause 1 year ago, which could be relieved by resting, and thought it was caused by irregular diet. He was not relieved by self-administered domperidone tablets and came to our hospital for consultation.
Physical examination: the patient was clear, mentally fine, thin, with pressure pain in the left upper abdomen, no rebound pain and muscle tension, no obvious masses were palpated, Murphy’s sign was negative, and there was no pressure pain at the McDonald’s point. For further treatment, the patient was advised to undergo abdominal CT examination, which showed that the patient had a hypodense lesion in the head and tail of the pancreas and a lobulated mass in the head of the pancreas containing a multifocal cyst; enhanced scan showed no enhancement of the contents of the multifocal cyst. The patient was considered to be a pancreatic plasmacytic cystadenoma and was admitted to the hospital for treatment.
(Figure: Hypodense lesion in the head and tail of the pancreas, lobulated mass at the head of the pancreas, containing multifocal cysts; enhanced scan showed no enhancement of the contents of multifocal cysts.)
II. Treatment history
After the patient was admitted to the hospital, further laboratory tests related to routine blood and urine, tumor markers, liver and kidney function, blood lipids, blood glucose, and ultrasound of abdominal organs were performed, and the results showed that the patient had elevated tumor markers, but the rest of the tests did not show any significant abnormalities. After the diagnosis was confirmed, we first explained the patient’s condition to the patient and his family, and the patient’s lesion involved the head and tail of the pancreas.
The operation lasted more than 3 hours and was successfully completed. The patient had a smooth intraoperative course and regular postoperative care such as wound dressing change was performed on time. After removal of pancreatic tumor, there may be increased secretion. Oral amoxicillin capsules were given to eliminate inflammation and promote wound recovery.
III. Treatment results
The patient had a smooth surgical procedure and the pancreatic tumor was removed successfully. 3 days after surgery, the patient’s vital signs were stable and no abnormality was seen in the surgical incision. In about 2 weeks of hospitalization, the patient’s skin at the incision basically recovered, and no infection and adverse drug reactions occurred in the course of medication. The patient indicated that abdominal pain, diarrhea, nausea and other uncomfortable symptoms basically did not reappear, and no other discomfort appeared, and no significant abnormalities were found in the abdominal CT examination, and he was discharged from the hospital in good condition.
IV. Notes
The patient’s condition improved after the post-surgery review, and I was happy for the patient. Since tumor disease is prone to recurrence, it is suggested that patients should pay attention to go to the hospital for regular checkups in daily life, including tumor markers, abdominal ultrasound, liver and kidney function, etc., and CT and MRI examinations should be performed when necessary to confirm the condition.
In addition, since surgery is an invasive operation, a certain amount of incision will be left behind. After discharge, it is necessary to ensure that the incision is dry and the skin near the incision is clean to avoid infection. After discharge from the hospital, try to avoid physical labor, but you do not need to be bedridden for a long time. You can do some mild activities and walk around more every day. Since emotions are closely related to the degree of the disease, patients are additionally advised to pay attention to rest and ensure sufficient sleep and a relaxed mood. Pay attention to a reasonable diet, do not eat greasy, spicy and stimulating food, do not overeat, and do not drink alcohol.
V. Personal insight
Plasmacytoid cystadenoma of the pancreas is relatively rare and generally grows slowly, but has the possibility of developing into malignant cystic adenocarcinoma. Most of the patients like this paper have clinical symptoms such as distension or vague pain in the upper abdomen, diarrhea and other gastrointestinal symptoms such as upper abdominal mass, weight loss, jaundice and gastrointestinal bleeding. Plasmacytic cystic tumors of the pancreas are mostly benign, and imaging examinations typically show honeycomb-like structures, which is significant for the diagnosis of cystic tumors of the pancreas.
In this article, the patient went to the hospital in time when the abdominal discomfort appeared again, and the tumor was detected and treated early so the prognosis is better. This tells us that ultrasound, CT and MRI are common auxiliary examinations for the diagnosis of pancreatic cystic tumor, which are of great significance for the diagnosis and treatment of the disease.