Case Report: Giant Pancreatic Cyst Removed by Enucleation in 68-Year-Old Man

A 68-year-old man with a giant mucinous cystic neoplasm of the pancreatic tail was successfully treated by enucleation, preserving the surrounding pancreatic tissue rather than removing that portion of the gland. The single-patient clinical report describes a cyst measuring approximately 24 × 17 cm that extended from the pancreatic tail toward the left kidney and pelvis. The case is unusual because giant mucinous cystic neoplasms are uncommon and these tumors occur predominantly in middle-aged women. The patient had experienced three years of dull, aching upper-abdominal pain, although he had no weight loss, jaundice, pancreatitis or other clear signs of an acute abdominal illness. The operation was performed without clinical, radiological or intraoperative suspicion of malignancy, and the specimen was removed intact and confirmed as a mucinous cystadenoma by histopathological examination.

Pancreatic cystic neoplasms are uncommon and are often discovered incidentally, with a reported prevalence of approximately 0.7% to 2.5% on computed tomography and magnetic resonance imaging. Mucinous cystic neoplasms, often abbreviated as MCNs, occur predominantly in women and usually arise in the body or tail of the pancreas. They generally do not communicate with the main pancreatic duct and may be unilocular or multilocular. Serous cystadenomas and mucinous cystadenomas are among the more common benign pancreatic cystic neoplasms, but giant MCNs are unusual. Most MCNs measure 1.5 to 10 cm, although lesions as large as 35 cm have been reported. The 24 × 17 cm lesion in this case therefore fell well outside the usual size range, while the patient’s sex and age also contrasted with the female predominance described in the literature.

The patient presented with a three-year history of dull, aching pain in the upper abdomen. The pain neither shifted nor radiated and had no clearly identified relieving or aggravating factors. It was accompanied by heartburn and dyspepsia, but his appetite remained normal and he reported no additional gastrointestinal symptoms. There was no previous history of jaundice and no feature suggesting acute pancreatitis. He was neither diabetic nor hypertensive, had undergone left inguinal hernia repair 10 years earlier, and reported no smoking or alcohol consumption. General and abdominal examinations were unremarkable, and no abdominal mass was palpable. His prolonged symptoms, absence of systemic warning signs and lack of a palpable mass did not identify the precise nature of the lesion before cross-sectional imaging.

Abdominal ultrasonography showed a huge cystic mass of indeterminate origin. Contrast-enhanced CT of the abdomen with oral and intravenous contrast demonstrated a very large unilocular cyst arising from the pancreatic tail and extending inferiorly toward the left kidney and pelvis. Additional CT images established the anatomical relationship between the lesion and the pancreatic tail. The liver appeared normal, with no ascites or lymphadenopathy identified. Serum amylase, carcinoembryonic antigen and carbohydrate antigen 19-9 were all within normal limits. The differential diagnosis included an MCN, pancreatic pseudocyst, serous cystadenoma and intraductal papillary mucinous neoplasm. Although the imaging and laboratory findings were compatible with a noninflammatory cystic lesion, they could not establish the tumor type. A normal carcinoembryonic antigen value also did not exclude an MCN because the marker can assist in identifying mucinous cysts but is not definitive by itself.

Exploratory laparotomy revealed a large retrogastric cystic mass arising from the pancreatic tail. It extended laterally toward the left kidney and inferiorly into the pelvis, matching the extent seen on CT. The surgeons released adhesions on the medial and lateral aspects through careful sharp and blunt dissection. They then completed enucleation and removed the mass intact, with its measured dimensions approximately 24 × 17 cm. Blood loss was minimal, and a surgical drain was placed. Analysis of the cyst fluid showed normal amylase and CA 19-9 levels, no bacterial growth and negative cytology. Histopathological examination of the removed tissue confirmed mucinous cystadenoma. The final diagnosis thus rested on direct examination of the specimen rather than imaging, serum markers or fluid analysis alone.

The postoperative course was uneventful. The drain was removed on postoperative day four, and the patient was discharged home in good condition. At follow-up, he remained asymptomatic and showed no evidence of recurrence. This outcome establishes that enucleation was technically feasible in this patient and was followed by uncomplicated immediate recovery. As a single case report without a comparison group, however, it does not show that the operation is equally safe for every giant pancreatic cyst, nor does it establish a reduction in long-term recurrence, operative morbidity or mortality. The evidence is limited to one selected case in which malignancy was not suspected and the lesion could be removed intact while preserving pancreatic tissue. The follow-up information reported in the article likewise does not permit assessment of very long-term durability.

The diagnostic difficulty in this case reflects the broader challenge of evaluating pancreatic cystic tumors. These tumors reportedly constitute approximately 10% to 15% of pancreatic masses and 1% to 10% of pancreatic malignancies. They may grow slowly and remain asymptomatic until they become large. In the absence of trauma or acute or chronic pancreatitis, a cystic pancreatic neoplasm should be considered rather than assuming that a pancreatic cyst is a pseudocyst, although the two can remain difficult to distinguish. CT and MRI have comparable diagnostic performance when differentiating benign from malignant pancreatic cystic lesions, while endoscopic ultrasound is useful for guided sampling. None of these approaches independently replaced histopathology in the reported case. The normal serum markers, negative cyst-fluid cytology and absence of visible malignant features supported the selected operative approach but did not constitute definitive evidence that the tumor was benign before removal.

The reported risk of invasive carcinoma in MCNs is approximately 7% to 12%. Features associated with greater concern include size greater than 4 cm, mural nodules and calcification. Surgical management depends on lesion type, symptoms, malignant potential, growth, anatomical location and technical considerations. Resection has been advocated for symptomatic large lesions, lesions with malignant potential and lesions showing rapid growth. In the present patient, the exceptional size was concerning, but no additional clinical or radiological features suspicious for malignancy were reported, and no malignancy was suspected during surgery. Histopathology ultimately identified a mucinous cystadenoma. The distinction is important: the case did not show that enucleation was appropriate merely because the tumor was large, nor did it establish a clinical rule for all MCNs. The authors frame the outcome as an example from a carefully selected patient in whom the mass was completely removed without clinical, radiological or intraoperative signs of cancer.

Pancreatic enucleation may preserve functioning pancreatic tissue and avoid some morbidity associated with major pancreatic resection. Previous reports have described favorable outcomes with enucleation in selected benign or low-grade pancreatic lesions. In the current case, the 24 × 17 cm mass was separated from the pancreas and recovered intact, with minimal blood loss and no complication during the postoperative recovery described in the report. The case adds an unusual example to the literature because it combines a giant MCN, an older male patient and a parenchyma-preserving operation. Its central contribution is not a general recommendation for conservative surgery. Instead, it documents that giant size alone did not preclude enucleation in this individual setting, where the lesion could be removed completely, the surrounding pancreatic tissue was preserved and the final pathology showed no malignancy.

For clinicians evaluating a giant pancreatic cystic neoplasm, the report supplies a documented example of enucleation rather than formal pancreatic resection. The operative decision in this case depended on the absence of clinical or radiological suspicion of malignancy, the findings during surgery and the ability to remove the lesion intact. CT had shown a unilocular cyst arising from the distal pancreas, while serum amylase, CEA and CA 19-9 were normal; the surgical specimen was later confirmed as a mucinous cystadenoma. The patient was discharged four days after surgery and remained well without recurrence at follow-up. The case therefore records a favorable immediate outcome for one carefully selected 68-year-old man with a giant pancreatic tail lesion, while its single-case design and limited follow-up leave the safety and effectiveness of the approach for other patients unestablished.

Subject of Research: Case report of enucleation for a giant pancreatic mucinous cystic neoplasm

Article Title: Giant Pancreatic Mucinous Cystadenoma Treated by Enucleation: A Case Report and Review of the Literature

Article References: Hussien, G. M., Arabi, N. A., Musaad, A. M., Mohamed, E. E., Mohamed, S. A., & Alarabi, T. G. M. (2026). Giant Pancreatic Mucinous Cystadenoma Treated by Enucleation: A Case Report and Review of the Literature. Clinical Case Reports, 14(10), Article e73732. https://doi.org/10.1002/ccr3.73732

Image Credits: AI Generated

DOI: 10.1002/ccr3.73732

Keywords: pancreatic cyst, mucinous cystic neoplasm, enucleation, pancreatic surgery, case report, giant cyst, computed tomography, histopathology, parenchyma-preserving surgery, Giant, Pancreatic, Mucinous