A 44-year-old woman has a 4.5 cm multiloculated cyst in the tail of the pancreas found on CT done for vague epigastric pain. There is no history of pancreatitis. Endoscopic ultrasound confirms thick septations, no communication with the pancreatic duct, and CEA in the cyst fluid is markedly raised while amylase is low. The most appropriate next step is:

• A Surveillance CT every 6 months
• B Distal pancreatectomy with splenectomy ✓
• C Cystogastrostomy
• D Total pancreatectomy

Explanation

A septated cyst in the pancreatic body or tail of a middle-aged woman with no pancreatitis history, high CEA, low amylase, and no duct communication is a mucinous cystic neoplasm. These lesions carry significant malignant potential, and all fit patients should undergo resection, which is distal pancreatectomy usually with splenectomy for a tail lesion. Histology characteristically shows ovarian-type stroma. Cystogastrostomy is a drainage operation for a mature pseudocyst and would be inappropriate here.

Reference: Blumgart's Surgery of the Liver, Biliary Tract and Pancreas, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.