Mucin-producing tumor of the pancreas associated with pyothorax: Report ofa case

We report herein the case of a 76-year-old man for whom an invasive mucin-p roducing tumor of the pancreas (MPTP) was successfully treated by surgery. A cystic lesion of the pancreas had been found by computed tomography (CT) 9 years earlier, 2 years following which suction drainage for left pyothora x had been carried out. A pancreatic cyst fistula to the thorax had subsequ ently been found during decortication for recurrent pyothorax 2 years later . Methicillin-resistant Staphylococcus aureus was detected in the pleural d ischarge after the thoracotomy, and thoracic fenestration was performed. A CT scan done 4 years later showed enlargement of the pancreatic cysts and a cystography revealed communication to the duodenum via the main pancreatic duct. Endoscopic retrograde cholangiopancreatography (ERCP) showed dilatat ion of the main pancreatic duct. The pancreatic cyst fistulated to the stom ach and to the fenestrated thorax. Since MPTP was suspected from this clini cal course, a distal pancreatectomy, partial gastrectomy, and omentopexy to the thorax were performed. The pathological diagnosis was intraductal papi llary-mucinous tumor of the pancreas with a megacyst. While MPTP is recogni zed as a low-grade malignancy, some cases of invasive disease have been rep orted. To the best of our knowledge, this is the first case of MPTP associa ted with pyothorax due to fistula formation.