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Ruptured Oncocytic Intraductal Papillary Neoplasm: Think Beyond the Pancreas

  • Christopher W. Jensen
  • David J. Worhunsky
  • George Triadafilopoulos
  • David B. Bingham
  • Brendan C. VisserEmail author
Stanford Multidisciplinary Seminars

Case Presentation and Evolution

A 73-year-old female was initially evaluated for weight loss, fatigue, abdominal pain, and massive ascites. A computed tomography (CT) scan showed a 14 × 14 × 18 cm complex cystic mass, anterior to the stomach, appearing to arise from the left hepatic lobe (Fig.  1). A paracentesis removed 6 L of viscous, gelatinous fluid with a serum–ascites albumin gradient of 3.8, consistent with a transudative process. Image-guided biopsy showed an oncocytic papillary neoplasm with scattered mucinous cells and bland cytology. Recurrent ascites necessitated a repeat paracentesis and eventual placement of a percutaneous drain. A staging positron emission tomography (PET)/CT scan showed no fluorodeoxyglucose (FDG)-avid lymphadenopathy or evidence of metastatic disease (Fig.  1). Preoperative liver function tests (LFTs) were normal, except for a mildly elevated alanine aminotransferase (ALT) of 70. The tumor markers carcinoembryonic antigen (CEA), CA 125, and CA 19-9 were...

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Christopher W. Jensen
    • 1
  • David J. Worhunsky
    • 2
  • George Triadafilopoulos
    • 3
  • David B. Bingham
    • 4
  • Brendan C. Visser
    • 2
    • 5
    Email author
  1. 1.Stanford University School of Medicine, Stanford UniversityStanfordUSA
  2. 2.Department of SurgeryStanford University School of MedicineStanfordUSA
  3. 3.Department of Gastroenterology and HepatologyStanford University School of MedicineStanfordUSA
  4. 4.Department of PathologyStanford University School of MedicineStanfordUSA
  5. 5.Stanford Cancer CenterStanford University Medical CenterStanfordUSA

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