A 63-year-old female with a painless, growing peripancreatic cystic mass.

Five years previously, this 63 year-old female was noted to have a 3cm peripancreatic cystic lesion on CT prior to laparoscopic cholecystectomy. During the uneventful laparoscopic cholecystectomy, the mass was not seen, and she was followed by abdominal CT every 6 to 12 months thereafter. Unfortunately, the patient was lost to follow-up. At a recent physical exam, she was found to have microscopic hematuria. Work-up for this hematuria has been inconclusive to date; however, an abdominal CT showed a 5.5.0 X 4.0 X 3.0 cm cystic lesion arising near the undersurface of the junction of the pancreatic body and tail.

Notable for microscopic hematuria on annual exam without known cause. Patient has no other complaints.

Patient has a history of fibromyalgia, hypertension, and osteoporosis.

Her past surgical history is notable for an appendectomy (1956), breast biopsies x 3 (1987, 1989, 1998 - all negative for tumor), peritonsillar abscess, dilation and curettage (1991) and a cholecystectomy (1998).

She denies illicit drug or tobacco use, and drinks alcohol occasionally. She has no known occupational exposures.

Her parents had hypertension and emphysema. Her sister had breast cancer. No family history of pancreatic or colonic carcinoma.

No known drug allergies. No known allergies to latex.

Triamterene/ hydrochlorothiazide 37.5mg/25mg qd, trazodone 50mg qd, potassium chloride 10mEq qd, alendronate 70mg qwk, OTC vitamin qd, calcium 600mg q2d.

The patient is a well-developed, well-nourished white female in no acute distress. Vital signs reveal blood pressure 141/74, pulse 79, respiratory rate 18, O₂ sat 98% on room air, and temperature 36.7C. Head and neck exam reveals no thyromegaly or lymphadenopathy. Lungs are clear to auscultation bilaterally. Cardiac exam is unremarkable with no murmurs, gallops, or rubs appreciated. Abdomen is soft, nontender, and nondistended. Rectal examination was normal, with hemoccult negative stool. There is no hepatosplenomegaly or periumbilical adenopathy. Neurological exam is unremarkable.

CBC: WBC 7230/mm³, HgB 14.6 g/dL, Hct 45.1%, MCV 88.8 fL, RDW 14.5%, platelets 252,000/mm³
Basic metabolic panel: Sodium 139 mEq/L, potassium 3.9 mEq/L, chloride 97 mEq/L, BUN 19 mg/dL, creatinine 1.0 mg/dL, glucose 95 mg/dL,
Liver function tests: Total protein 8.1 g/dL, albumin 4.9 g/dL, total bilirubin 1.4 mg/dL, ALT 17 IU/L, AST 22 IU/L, alkaline phosphatase 65 IU/L
Amylase 50 IU/L, Lipase 47 IU/dL
Ca²⁺ 9.7 mg/dL
CA 19-9 = 8.5 U/mL (1-36)
CEA = 0.7 U/ml (0.0-3.0)

Images 1 and 2 are axial images from a contrast enhanced CT demonstrating a low density mass abutting the pancreas. Image 3 is a coronal 3D image demonstrating displacement of the mesenteric veins by the mass, without encasement. Image 4 is a sagittal 3D image demonstrating the celiac axis and SMA, which are not involved by the mass.

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