PAPILLARY CYSTIC NEOPLASM OF THE PANCREAS WITH LIVER METASTASIS COEXISTING WITH THYROID PAPILLARY CARCINOMA

Background.-Papillary cystic neoplasm of the pancreas is an uncommon n eoplasm that usually appears to be benign or to have a very low potent ial for metastasis. We report a case of a patient with papillary and c ystic neoplasm of the pancreas, which metastasized to the liver and co ncomitantly presented a stage I thyroid papillary carcinoma. Case Desc ription.-The patient was a 38-year-old woman with a 12-year history of abdominal pain. She was first admitted to the hospital 3 years after symptoms began, and an exploratory laparotomy revealed a pancreatic cy stic lesion that was diagnosed as a pancreatic pseudocyst, which drain ed by cystojejunosotomy. Nine years after onset, a stage I thyroid pap illary carcinoma was excised. One-and-a-half years later, the patient was readmitted to the hospital for evaluation of a palpable abdominal mass. Abdominal computerized axial tomography disclosed a large pancre atic tumor and two nodular lesions of the liver. Papillary cystic neop lasm of the pancreas was diagnosed by cytologic, histologic, and ultra structural studies of samples obtained directly from the pancreatic ma ss using fine-needle aspiration biopsy. The patient underwent palliati ve chemotherapy with mitomycin C, 4-epiadriamycin, and 5-fluorouracil. One year after this treatment began, a computerized axial tomography scan showed persistence of the pancreatic mass, with more prominent cy stic spaces, increase in size and in number of the lesions in the live r, slight increase in the lesion of the right ovary, and a new lesion that also had solid and cystic areas in the spleen. Conclusion.-The pa thologic and clinical features of patients with papillary cystic neopl asm of the pancreas, based on tumoral extension, reveal localized tumo rs (88.2%), tumors with local infiltration or recurrence (6.2%), and t umors with metastasis at a distance (5.6%). Although strong similariti es exist among the three groups, there are certain differences in age of presentation, previous clinical diagnosis of pseudocyst, and tumor location.