Silent existence

Case notes

A 63-year-old woman was referred to our institute, because a lesion of the pancreatic tail, an incidental finding during a general health examination, was progressively enlarging. At the time of admission, she did not have abdominal pain, bowel discomfort, or weight loss. Her physical examination was unremarkable, except for a surgical scar located low on the abdomen. She had undergone hysterectomy and left salpingo-oophorectomy 9 years earlier because of postmenopausal vaginal bleeding. Pathologic examination of that surgical specimen showed uterine leiomyomas and a granulosa cell tumor (GCT) of the left ovary.

Abdominal computed tomography disclosed a well-defined, heterogeneously-enhanced mass in the pancreatic tail region ( Figure 1 , arrow ). Serum tumor marker levels, including cancer antigen (CA)-19-9, CEA, and CA-125, were all within reference ranges. The patient underwent laparoscopic tumor resection for a presumed pancreatic malignancy. A well-demarcated retroperitoneal tumor was found in the left upper abdomen ( Figures 2-4 ). The tumor was close to the pancreas but was not adhered to it.