Journal of Surgical Case Reports

Robotic left hepatectomy for the management of mucinous cystic neoplasm of the liver with atypical presentation inside the biliary tract: a case report

Abstract Mucinous cystic neoplasm of the liver (MCN-L) is a rare epithelial tumor with ovarian-like stroma (OLS), accounting for less than 5% of hepatic cysts. While usually confined to the liver, MCN-L rarely invades the biliary tract, complicating diagnosis and treatment. This case report describes a 53-year-old woman with recurrent cholangitis after robotic hepatic resection for MCN-L. Imaging revealed a lesion in the bile ducts, initially suspected to be intraductal papillary neoplasm of the bile duct (IPNB). Robotic left hepatectomy using the Da Vinci platform was performed, and intraoperative findings confirmed an intraductal pedunculated mass. Histopathology identified MCN-L with OLS invading the biliary tract. The patient recovered uneventfully and was discharged on postoperative day two. Although rare, MCN-L with biliary invasion can mimic IPNB. Robotic surgery provides a minimally invasive solution, emphasizing the importance of early detection and intervention for optimal outcomes.

A case of torsioned giant mucinous cystadenoma mimicking mesenteric cyst

Abstract Ovarian mucinous cystadenomas are cystic neoplasms lined by mucin-producing epithelial cells. They account for ~15%–20% of ovarian tumors, and in 80% of the cases, they are benign. Intra-abdominal mucinous cystic neoplasms commonly arise from the ovaries but can rarely arise from the mesentery. Here, we report a case of a 49-year-old para II mother who presented with a complaint of progressive abdominal swelling and discomfort of 6 months duration. She had an ill-defined mass around the peri-umbilical and lower abdominal area. Abdominopelvic ultrasound suggested a mesenteric cyst, while computed tomography showed a large, thick-walled cystic lesion of ovarian origin. Determining the tissue of origin of a giant cyst that involves both the mesentery and adnexa is difficult. Torsion of a massive ovarian cyst is a rare gynecologic emergency that involves both diagnostic and management challenges. No matter the diagnostic dilemmas, surgery is the mainstay of treatment.

Growth and rupture of pancreatic mucinous cystic neoplasm following hormonal stimulation for in vitro fertilization: a case report

Abstract Mucinous cystic neoplasms (MCNs) of the pancreas are rare mucin-producing epithelial tumors that predominantly affect middle-aged women and typically contain ovarian-type stroma responsive to hormonal stimulation. While progression and rupture of MCNs during pregnancy have been documented, the effects of exogenous hormonal stimulation remain uncertain. We present a unique case of a 39-year-old woman who experienced rapid cystic enlargement and rupture of a pancreatic MCN following hormonal therapy for in vitro fertilization (IVF). Imaging demonstrated progressive cyst growth with radiologic evidence of rupture, which was confirmed intraoperatively. Histopathological analysis revealed an MCN with low-grade dysplasia and immunohistochemical positivity for estrogen receptors. This case represents the first description of a potentially severe complication of gonadotropin stimulation in pancreatic MCNs and underscores the importance of screening for cystic pancreatic lesions in patients undergoing assisted reproductive therapies.