title: Mucinous cystic neoplasm of the pancreas with severe dysplasia during pregnancy: case report and review of the literature.
abstract: OBJECTIVE
  Mucinous cystic neoplasm (MCN) of the pancreas occurs mainly in women aged 40-60 years, so it is extremely rare in pregnant woman.
  
  
  METHODS
  A 28-year-old woman in the ninth week of pregnancy was referred to our hospital due to a tumor of the abdominal cavity. Abdominal ultrasound demonstrated a huge multicystic lesion in the left upper abdomen. There are mural nodules and hypertrophic septa partially with the presence of blood flow inside the tumor. Endoscopic ultrasonography was performed and a diagnosis of possible pancreatic MCN was made. At the second trimester, distal pancreatectomy with splenectomy was performed. Histopathological analysis of the specimen revealed a pancreatic MCN with severe dysplasia. Immunohistochemically, the tumor was positive for both progesterone and estrogen receptors in the stromal cell nuclei; moreover, MIB-1 stained positive in 10-20% of the nuclei in the epithelium with severe dysplasia.
  
  
  CONCLUSIONS
  MCN carries malignant potential, therefore, early detection and complete surgery is recommended. MCN in pregnancy is rare and the abdomen is distended during pregnancy, so clinicians can easily miss the presence of the tumor. We should recognize the presence of MCN in pregnant woman. We speculate that the presence of blood flow within the tumor and MIB-1-positive cells can be a predictor for premalignant or malignant MCN.
authors.affiliation: Department of Obstetrics and Gynecology, Nagoya University School of Medicine, Nagoya, Japan. hiro-t@med.nagoya-u.ac.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsuda
authors.forename: Tomomi
authors.initials: T
authors.lastname: Kotani
authors.forename: Seiji
authors.initials: S
authors.lastname: Sumigama
authors.forename: Yukio
authors.initials: Y
authors.lastname: Mano
authors.forename: Yoshie
authors.initials: Y
authors.lastname: Shimoyama
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Kikkawa
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D019394:Ki-67 Antigen / Q000378:metabolism; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism
chemical_list: D019394:Ki-67 Antigen; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone