Young male 42 years old presented biliary colic. During hospital stay SHE underwent a ct that revealled an incidental cystic heterogeneus lesion ( 2,8 cm) of tail of the pancreas. This patient presented normal levels of both amylase and lipase and never had a pancreatitis. This lesion presented a septum and after administration of the contrast there was an enhacement of as its capsule as its septum. MRI revealled no comunication with wirsung duct. This patient underwent an echoendoscopy that revealled cystic heterogeneus lesion 25 mm close to the splenic vein. After punction of this lesion it was observed a haemorragic liquid with debris. ca 19.9 and cea of this liquid is very low and amilase 345,0 ng dl. So, we excluded serous and ipmn ( type 2), but no Frantz or even pancreatic net with necrosis and haemorragy. we should perform lap chole then is it worthwhile to resect this lesion? Or should observe its? Should i repeat these exams ? How long should it be the frequency? Is it worth a pet ct?
Dear Sergio, we need to look at images because sometimes another diagnosis may be also possible. Anyway, a very young female with an heterogenous cystic tumor in the tail of the pancreas I would not hesitate to resect it. However, spleen should be absolutely preserved in such case, in my opinion. Unless the close relationship with splenic vessels make it impossible. Good luck. If you can post the images we can contribute better.
Dear prof marcel! This is a good case for spleen preservation i was thinking in first to try kimura but if is difficult to preserve the slpenic vein to perform warshaw. Thanks once!
Dear
He is an adult patient, with a small lesion.
Recent paper shows that the risk of imaging following up for possible growing is the same of normal population. Sorry, but Frantz tumor occurs in very young female patient, in the majority of cases above 5 cm, initially as a solid lesion, and posterior necrosis. Absence of mucina. Low tumor Marker, Low amilase, Absence of neoplasia cell.
So, I will repit the exams with 3 months.
Thanks
We have a series that was published in Eisntein 2007; 5(2): 161-5. where we observed a presence of necrosis and haemorragic liquid in all of the cases beyond and age untill lates thirties. My first laparoscopic distal pancreatectomy near 10 years ago it was to the small frantz on the tail (2 cm lesion) , this patient is alive today. Thanks once!
Off course you could follow this patient up. I am not sure which tumor she has but I know that sometimes echoendoscopy biopsy may not be so accurate that we would like. The operation will not incur in splenectomy, the amount of pancreas to be removed will be dismal and we will have the final diagnosis. She is only 42-year-old and she will need a long follow-up. If she is fit for the surgery. I will carry out the operation.
We publish in Surgery, our experience with Frantz tumor in 2008. It may occur in women and in men. In our series, as young as 10 years or as old as 72 years old. The tumor was between 1.5 cm and 15 cm.
Machado M et al. Solid pseudopapillary neoplasm of the pancreas: distinct patterns of onset, diagnosis, and prognosis for male versus female patients. Surgery 2008; 143 (1): 29-34.
Dear friends. After many cases of cystic tumors which we operated, i never saw neither serous nor mucinous even ipnm whereas the content of the inside liquid was haemorragic with debris. In my humble opinion this case is a Frantz or less probably a cystic pancreatic neuroendocrine tumor, this late diagnosis we also resolved by means of surgical resection even being low-grade because is bigger than 2 cm. I think that it is no absurde to offer resection in this case because the morbidity of laparoscopic distal pancreatectomy is relativelly low and we will operate the gallbladder in this case.
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