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Diagnostic puzzle: Can you decipher by imaging only the nature of the cystic pancreatic lesion that is described below?

  • Original Article
  • Published:
Hellenic Journal of Surgery

Abstract

Background-Aim

Nowadays, pancreatic cysts represent a popular topic among the medical scientific community because of their increased prevalence. They usually present as an incidental finding at radiology imaging. The probability of correctly diagnosing the nature of a pancreatic cyst, preoperatively, varies from absolute certainty to complete uncertainty. Hence, seizing the opportunity of a female patient, the aim of this study was to compose a well-structured approach to establishing the precise diagnosis of a pancreatic cystic lesion using several key factors.

Case Description

We describe the case of a young 22-year-old female patient who presented with a palpable mass in the left hypochondrium with the only symptom being that of mild nausea with intermittent vomiting which had begun one week before her admission to our hospital.

Method

After meticulous evaluation of the patient based on medical history, radiologic imaging, endoscopic ultrasonography and laboratory tests, we established the initial diagnosis of a cystic pancreatic lesion. But the question of preoperative assessment as to the precise nature of that cystic lesion remained. After much reflection and consideration, we attempted to answer this question using the argumentation of “reductio ad absurdum” so as to achieve a sensible result.

Conclusion

Participating in this diagnostic game in search of the key to deciphering the nature of the pancreatic cyst preoperatively, we discovered that the game in question is demanding and fraught with difficulties. It is a puzzle tailored for strong players because notwithstanding the diagnostic armamentarium used, determining the precise nature of the cystic pancreatic lesion is not always feasible since several types of lesions are implicated.

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Authors and Affiliations

  1. 2nd Surgical Department and Surgical Oncology Unit, Red Cross Hospital “Korgialeneio-Benakeio”, Athens, Greece

    Andriana Kouloura, G. Sourtse, A. Pintireki, S. Peristeraki, K. Karkoulias, S. Lanitis, G. Sgourakis, P. Brotzakis & C. Karaliotas

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  1. Andriana Kouloura
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  2. G. Sourtse
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  3. A. Pintireki
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Correspondence to Andriana Kouloura.

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Kouloura, A., Sourtse, G., Pintireki, A. et al. Diagnostic puzzle: Can you decipher by imaging only the nature of the cystic pancreatic lesion that is described below?. Hellenic J Surg 87, 258–267 (2015). https://doi.org/10.1007/s13126-015-0219-0

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  • DOI: https://doi.org/10.1007/s13126-015-0219-0

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