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JAMA Oncology Clinical Challenge
January 19, 2017

Large Epigastric Cystic Lesion in a Pregnant Woman

Author Affiliations
  • 1Department of Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston
  • 2Department of Pathology, McGovern Medical School at the University of Texas Health Science Center, Houston
  • 3Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston
JAMA Oncol. Published online January 19, 2017. doi:10.1001/jamaoncol.2016.5846

A primigravid woman in her 20s who had been pregnant for 16 weeks presented with significant abdominal pain. A noncontrast computed tomographic (CT) scan revealed a 15 × 13 × 11-cm heterogeneous cystic mass that appeared to originate from the body of the pancreas and protrude into the gastric wall (Figure 1, A). Results of CT scan also revealed a 3-cm hypodense lesion on the left lobe of the liver, ascites, and splenomegaly. Further evaluation with endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography revealed extrinsic compression of the gastric wall from a large mixed solid/cystic lesion with septations and well-defined margins with no clear involvement of the gastric wall. A thin, reddish-brown fluid (700 mL) was aspirated from the cystic component. Analysis of the aspirate showed no tumor cells or mucinous material, and normal carcinoembryonic antigen, CA19-9, and amylase. Fine-needle aspiration was performed on the solid component of the cystic tumor (Figure 1, B-E).

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