Pathological Case of the Month | Gastroenterology | JAMA Pediatrics | JAMA Network
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Special Feature
January 1999

Pathological Case of the Month

Author Affiliations

From the Division of Pediatric Pathology, James Whitcomb Riley Hospital for Children, 2536, Indianapolis, Ind.



Arch Pediatr Adolesc Med. 1999;153(1):89-90. doi:

A 15-YEAR-OLD white girl presented with a history of acute, left upper quadrant abdominal pain that developed while she was performing gymnastics. She had no history of trauma or pancreatitis. An abdominal computed tomographic scan revealed a large mass in the tail of the pancreas. The differential diagnosis based on the computed tomographic scan included pancreatic pseudocyst and papillary cystadenoma. An endoscopic retrograde cholangiogram and pancreatogram showed a J-shaped stomach consistent with extrinsic compression, an inferiorly displaced main pancreatic duct with a smooth, tapered narrowing, and no filling of the pancreatic tail. There was no evidence of communication of the pancreatic duct with the mass. The cholangiogram showed no abnormalities. Exploratory laparotomy showed a large mass involving the pancreatic tail and adherent to the splenic artery and vein. A distal pancreatectomy and splenectomy was performed; the gross specimen showed an 11-cm-diameter mass that markedly distended the pancreatic tail (Figure 1). On cut section, the mass had a multicystic, hemorrhagic, and necrotic appearance (Figure 2). The tissue was examined histopathologically (Figure 3).