A rare case of pancreatic endometriosis in a postmenopausal woman and review of the literature

Abstract

Pancreatic endometriosis is very rare with only a few cases reported in the literature. The imaging features are non-specific and the definitive diagnosis is usually only established after surgery. We report on a 68-year-old woman with left upper quadrant pain who demonstrated a mass in the pancreatic tail on imaging. Laboratory results showed only mildly elevated liver enzymes, tumor markers were within the normal range. A left pancreatectomy was performed, frozen section suggesting a benign lesion, and final histopathology confirmed endometriotic cysts. A research of the literature found only eight reported cases of endometriotic cysts of the pancreas, with the majority affecting premenopausal women. Preoperative diagnosis is challenging and most patients undergo resection because of suspected neoplasm. Thorough diagnostic workup may help in avoiding extensive surgery and reduce postoperative complications.

Pancreatic endometrial cyst mimics mucinous cystic neoplasm of the pancreas

“…The expanded differential diagnosis for this case includes Mucinous cystic neoplasm (MCN) of the pancreas, pancreatic pseudocyst, serous cystadenoma, serous cystadenocarcinoma, solid pseudopapillary tumor, cystic pancreatic adenocarcinoma, cystic pancreatic neuroendocrine tumor, and ectopic tissue. Endometrial cysts in the pancreas are exceedingly rare lesions that are difficult to diagnose pre-operatively[ 1 , 6 - 15 ]. This report describes the findings of a giant endometrial cyst of the pancreas in a patient with a recent episode of acute pancreatitis.…”

“…There are multiple theories for the pathogenesis of endometriosis, which include direct extension, menstrual regurgitation, lymphatic/vascular spread, and coelomic metaplasia[ 5 ]. The most common sites of endometriosis are the pelvic organs[ 5 ]; however, endometriosis of the upper abdominal organs has been described[ 1 , 6 - 15 ]. Endometrial cysts of the pancreas remain an exceedingly rare entity.…”

“…The most common sites of endometriosis are the pelvic organs[ 5 ]; however, endometriosis of the upper abdominal organs has been described[ 1 , 6 - 15 ]. A literature review identified 12 previous cases of pancreatic endometriosis[ 1 , 6 - 15 ]. Each of these patients underwent surgical resection because a malignant or pre-malignant lesion could not be ruled out.…”

Endometriosis-associated ovarian carcinoma site in particular structures of the abdominal cavity and the pelvis

“…abdominal integuments. Endometriosis present outside the pelvis is rare, however, the literature presents some findings concerning respiratory tract endometriosis, pericardial endometriosis or endometriosis in a scar following a laparotomy (2,3) . It is currently deemed that endometriotic origin should be sought in the case of every recurring, monthly pain in a woman at a productive age.…”

“…powłok brzusznych. Endometrioza występująca na zewnątrz miednicy jest zjawiskiem rzadkim, jednak w literaturze można znaleźć doniesienia o endometriozie układu oddechowego, endometriozie osierdzia czy w bliźnie po operacjach z dostępu laparotomijnego (2,3) . Obecnie uważa się, że endometriotyczne podłoże należy podejrzewać w przypadku każdego nawracającego, comiesięcznego bólu u kobiety w wieku rozrodczym.…”