Abstract
Mucinous Cystic Neoplasms (MCNs) of the pancreas are rare, typically affecting women and carrying potential for malignant transformation. While complications like fistulas between MCNs and adjacent structures are rarely reported, this case presents the first documented fistula between a pancreatic MCN and the portal venous system. A 56-year-old woman with acute abdominal pain was found to have a 10.4 cm cystic mass in the pancreatic tail, consistent with an MCN. The lesion exhibited high-risk features. During her admission, a progressive venous filling defect, presumed to be a thrombus, developed despite anticoagulation therapy. Percutaneous thrombectomy revealed a communication between the splenic vein and the cystic mass, with mucinous content aspirated, confirming a fistula with direct extension of mucin into the vein. Distal pancreatectomy confirmed the diagnosis of an MCN with high-grade dysplasia and ovarian-like stroma. This case highlights the rare occurrence of a fistula between a pancreatic MCN and the portal venous system, underscoring the importance of early recognition for proper treatment and surgical planning.
Main Subjects
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