Ruptured Oncocytic Intraductal Papillary Neoplasm: Think Beyond the Pancreas
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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