Papillary Cystadenocarcinoma of Pancreas: Case Report, with Notes on Classification of Malignant Cystic Tumors of Pancreas

The case here reported is interesting both because of the rarity of the tumor and because the complete clinical record over a period of six years may throw possible light upon the pathogenesis of the neoplasm. The latter was an encapsulated cystic tumor of the tail of the pancreas, the size of a child9s head, which, after an interval of about five years, had, in part, undergone carcinomatous change, invading the capsule and metastasizing to the peritoneum, omentum, and liver. Large papillary cystadenocarcinomata of the pancreas of this type are admittedly rare (Kaufmann, 1; Ewing, 2), especially cases proved by adequate necropsy or biopsy data. In fact, there appears to be no authentic case report in the American literature. Malignant cystic tumors of the pancreas of all types have, of course, been described with increasing frequency within the past twenty years. Only a very small proportion of these, however, are cystadenocarcinomata in the specific sense of the author9s case, as will be seen later from a brief survey of the literature. Report of Case 2 The patient, a female nurse, a Russian, aged forty-four, single, first came under observation at the Mount Sinai Hospital in December 1928 (three years before necropsy), with a complaint of intermittent edema of the ankles of six years9 duration, pain in the left thigh, and a tendency to fatigue. In 1919, a hemorrhoidectomy had been performed. In November 1925, approximately six years before death, the patient had been observed for a period of two weeks at another hospital in New York City, where an exploratory laparotomy was performed for suspected acute intestinal obstruction. At operation, marked distention of all the intestine, including the sigmoid colon, was found, as well as marked edema of the mesosigmoid and an appreciable quantity of free serous fluid in the abdomen. The uterus showed a large intramural fibromyoma. The adnexa and appendix appeared normal. No intestinal obstruction was found, and the cause of the distention and peritoneal effusion was not clear. The patient was discharged improved. Shortly afterwards, her “spleen was felt to be enlarged.”