Vol 39 # 2 June 2007 - Kma.org.kw

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June 2007KUWAIT MEDICAL JOURNAL 169excision of mesenteric cyst. J laparoendosc Surg 1993;3:395-3994. Morrison CP, Wemjss-Holden SA, Maddern GJ. A noveltechnique for the laparoscopic resection of mesenteric cysts.Surg Endosc 2001; 15:556 - 559.5. Bless DP, Coftin CM, Bower RS, Stockmann PJ, Ternberg JL.Mesenteric cyst in children. Surgery 1994; 115:571-577.6. Sardi A, Patrick KJ, Minken SL. Mesenteric cyst. Am J Surg1987, 53: 58-60.7. Kurts RJ, Heimann TM, Holt J, Beck AR. Mesenteric andretro peritoneal cysts. Ann Surg 1986; 203:109-112.8. Mason JE, Soper NS, Burt LM. Laparoscopic excision ofmesenteric cyst, a report of two cases. Surg Laparosc Endosc& Percutan Techn 2001; 11:382-384.9. Hardi WS, Hardly SD. Mesenteric cysts. Am J Surg 1970;119:640-645.10. Ross PP, Olmsted WW, Moser RP, Datchmann HjermstadBH, Sobin LA. Mesenteric and omental cyst classificationwith imaging correlation. Radiology 1987; 164:327-332.11. Leiw SC, Glenn DC, Stoney DW. Mesenteric cyst: Reviewarticle. Aust NZ J Surg 1994; 64:741-744.
KUWAIT MEDICAL JOURNAL June 2007Case ReportSolid and Papillary Epithelial Neoplasm (SPEN) of thePancreas in a Pregnant LadyMargaret Linny Austin 1 , Sameer M Humad 1 , Vinod Kumar Grover 21Departments of *Radiology and 2 Surgery, Al-Jahra Hospital, KuwaitKuwait Medical Journal 2007, 39 (2):170-173ABSTRACTState-of-the-art cross-sectional imaging has led to therealization that the prevalence of cystic neoplasms in thepancreas is much higher than initially estimated. This hasalso permitted the diff e rentiation of most cystic neoplasmsbased on cyst size, shape, wall thickness, internalarchitecture, location and presence of calcifications. Thesolid and papillary epithelial neoplasm (SPEN) of thepancreas is a rare low-grade cystic malignancy, seenmainly in adolescent and young adult females. Wepresent the imaging findings of SPEN of the pancreas ina young pregnant lady that was accurately diagnosedpreoperatively.KEYWORDS: imaging, pancreas, SPENINTRODUCTIONSolid and papillary epithelial neoplasm of thepancreas (SPEN) is a rare low-grade malignancymainly found in adolescent and young women ofAsian and far Eastern origin. Clinically, patients areasymptomatic or may present with non-specificsigns and symptoms including nausea, vomitingand upper abdominal discomfort caused by theusually great size of the tumor. Surgical resection iscurative in most instances [1,2,3] .CASE REPORTA 34-yr-old Arab pregnant lady, a mother of six,presented with complaints of a dragging sensationin the upper abdomen. The gestational age of herfetus was 16 weeks at the time of examination.T h e re was no history of previous biliary tractdisease, pancreatitis, or trauma. She denied rearinganimals at home. There were no complaints ofarthralgia. Her laboratory tests including her bloodand eosinophil count were normal.Ultrasound of 8/2/2003 revealed a 14 x 11 cmwell encapsulated complex, heterogeneous masswith cystic and solid components in the tail of thep a n c reas, displacing the spleen laterally andcompressing the left kidney posteriorly withoutevidence of invasion. The cystic mass showedposterior enhancement (Fig. 1). The other organs,including the liver, spleen, kidneys, gallbladderand biliary tract were normal. Pelvic ultrasoundrevealed a single live fetus (of gestational age 16weeks) in the uterine cavity. The ovaries andadnexae were normal. There was no free fluid.Because of the high radiation dose delivered bycomputed tomography (CT) abdomen to thepatient and in particular to the fetus, it was decidedto proceed to magnetic resonance imaging (MRI) ofthe abdomen rather than CT scan. MRI revealed awell encapsulated predominantly cystic mass (asrevealed by the low signal on T1- Fig. 2 and highsignal on T2- Fig. 3) with peripheral mural orfrond-like areas of intermediate signal intensitydue to the solid component. The fat suppressedimages emphasized the cystic nature of the mass(Fig. 4). Gross hemorrhage was not pre s e n t ,although a minimal hemorrhagic component couldnot be excluded. The fibrous capsule was seen as ahypointense rim on T1 and T2. Administration ofgadolinium would have enhanced the evaluationof this tumor but was refused by the patient, eventhough its use is safe for the mother and the fetus.Because of the clinical presentation and theradiographic findings, the strong possibility of aSPEN of the pancreas was raised.On ultrasound guided aspiration of the cyst, 40ml watery blood stained fluid was withdrawn.Cytology from the solid area of the cyst and fluidshowed few sheets and dispersed small cuboidalepithelial cells without nuclear atypia and withscanty cytoplasm, macrophages, eosinophils andneutrophils. Findings were suggestive of a benignepithelial neoplasm.Address Correspondence to:Dr. Margaret Linny Austin, Dept. of Radiology Al-Jahra Hospital, Kuwait. P O Box 21396 Safat 13074, Kuwait. Tel: +965- 4577198, E-mail:Linny_Austin@Hotmail.Com
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Page 59 and 60: 146Outcome of Non-operative Managem
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Page 63 and 64: 150Total Thyroidectomy for Bilatera
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Page 77 and 78: 164Obesity and Cardiovascular Risk
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Page 111 and 112: 198Forthcoming Conferences and Meet
Page 117 and 118: 204WHO-Facts Sheet June 2007years,
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Page 123 and 124: التأثير الاقتصادي
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