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Pediatric Pancreatic Pseudocyst Presenting as a Solid Perigastric Mass: An Uncommon Diagnostic Pitfall
Giulia Maisano1, Antonio Ieni1, Salvatore Arena1
1Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, Messina, Italy, unime.it.
Insights
This case study highlights a rare solid pancreatic pseudocyst in a child without prior pancreatitis or trauma. Histopathological examination proved crucial for diagnosis when imaging was inconclusive.
Area of Science:
- Pediatric Gastroenterology
- Surgical Pathology
Background:
- Pancreatic pseudocysts are uncommon in children, usually linked to pancreatitis or trauma.
- Typical imaging reveals fluid-filled collections, aiding diagnosis.
Purpose of the Study:
- To report a rare case of a pediatric pancreatic pseudocyst with an unusual solid presentation.
- To emphasize the diagnostic challenges and importance of histopathology in unclear cases.
Main Methods:
- A 3-year-old girl with an incidentally detected perigastric mass underwent ultrasound and 8-month follow-up.
- Laparoscopic excision was performed for diagnosis and treatment.
- Histological and immunohistochemical analyses were conducted.
Main Results:
- The mass presented as a heterogeneous, hypoechoic lesion, atypical for a standard pseudocyst.
- Normal pancreatic enzymes and inconclusive imaging findings were noted.
- Histopathology confirmed a pancreatic pseudocyst, despite the unusual solid appearance.
Conclusions:
- This case underscores the possibility of solid-appearing pancreatic pseudocysts in children, even without a history of pancreatitis or trauma.
- Definitive histopathological examination is vital for accurate diagnosis and management when imaging is ambiguous.
Abstract:
Pancreatic pseudocysts are rare in children and typically arise after episodes of pancreatitis or abdominal trauma. Their diagnosis generally relies on imaging studies, where they are expected to appear as fluid-filled collections. We describe a case of a 3-year-old girl who has no previous occurrences of pancreatitis or trauma, in whom an unexpected heterogeneous, hypoechoic perigastric mass was incidentally detected during an ultrasound examination. The lesion demonstrated a consistent, firm appearance during an 8-month follow-up period and continued to be without symptoms. Laboratory examinations, including pancreatic enzymes assay, returned normal results, and imaging studies could not determine its characteristics. A laparoscopic excision was conducted for both diagnostic and treatment reasons. Histological and immunohistochemical analysis confirmed the diagnosis of a pancreatic pseudocyst. Postoperative recovery was uneventful. This case demonstrates a rare solid appearance of a pancreatic pseudocyst in a child who does not have previous pancreatic disease, emphasizing the critical importance of histopathological examination and surgical intervention when imaging results are unclear.
