A 39-year-old woman was admitted to our hospital with a complaint of abdominal pain for one day. There was no obvious precipitating factor, no weight loss and no family history of cancer. A physical examination showed mild tenderness in the left hypochondrium. Laboratory tests, including serum tumor markers, were normal.
The ultrasonography and CT findings of the tumor were as follows: (1) Location: the tumor was located at the body and tail of the pancreas; (2) Shape: it was irregular, approximately 10 cm × 7 cm in size, and had a clear border (Figures and ); (3) Composition: it was a cysticsolid tumor. The cystic area, with a mean CT attenuation value of 30 Hounsfield units (HU), comprised the main part. There was a cord-like septum in the center of the cystic area (Figure , arrow). The solid part was located at the back of the tumor, with a mean CT attenuation value of 68 HU (Figure , arrow); (4) Enhancement: it showed almost no change on contrast-enhanced CT images (Figure -D, Figure -H) compared with pre-contrast images, as assessed with the CT attenuation value; and (5) Neighborhood: the adjacent organs were compressed, and no enlarged lymph nodes were found. Based on these findings, mucinous cystadenoma or cystadenocarcinoma was initially considered.
Ultrasonography. The tumor is located at the body and tail of the pancreas and is irregularly shaped. The cystic part has a low-intensity echo level, and the solid part (arrow) displays an isointense echo.
Figure 2 Computed tomography images. A-D: There is a septum (arrow) in the center of the cystic part. Neither the cystic part nor the septum shows enhancement in the arterial phase (20 s after contrast injection) (B), pancreatic phase (45 s after contrast injection) (more ...)
The patient underwent an exploratory laparotomy. During the operation, the mass was identified as a large dark red mass located at the body and tail of the pancreas, slightly adhering to the gastric wall, posterior peritoneum and left kidney, with bloody fluid inside. Pancreatic body-tail resection combined with splenectomy was performed. Microscopically, some dysplastic lymphatic vessels and blood vessels were observed in the tumor (Figure ). The pathological diagnosis was hemolymphangioma. Her postoperative course was uneventful. She is currently enjoying a normal life without signs of recurrence.
Pathological sections. Some dysplastic lymphatic vessels (A) and blood vessels (B) can be observed in the tumor. Hematoxylin and eosin stain, × 100.