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Pancreatic cancer rarely develops cystic ovarian metastasis. We present a 63-year-old female patient with unresectable pancreas head cancer. Seven months after the introduction of the chemoradiotherapy, a giant intrapelvic cystic tumor with rapid growth was found. The tumor was resected because the patient complained of severe bloating and no other new metastatic sites could be identified. Postoperative pathological examination diagnosed it as an ovarian metastasis from the pancreas cancer.

Pancreatic cancer rarely develops cystic ovarian metastasis. We present a 63-year-old female patient with unresectable pancreas head cancer. Seven months after the introduction of the chemoradiotherapy, a giant intrapelvic cystic tumor with rapid growth was found. The tumor was resected because the patient complained of severe bloating and no other new metastatic sites could be identified. Postoperative pathological examination diagnosed it as an ovarian metastasis from the pancreas cancer.

A young man, aged 24, was investigated because of progressive abdominal distension. On examination, he had a large mass in the mid-abdomen. A contrast-enhanced computed tomography (CT) scan revealed a mass, 25 x 17 x 11 cm, in the mid-abdomen as shown on the axial and coronal scans in Figure 1. The mass had a heterogeneous appearance but many areas of the mass were of low-density consistent with fat. The preoperative diagnosis was that of a retroperitoneal liposarcoma. Laparotomy revealed a relatively firm tumor with a smooth surface (Figure 2). The mass appeared to arise from the body of the pancreas with sparing of the tail of the pancreas (arrowheads). A resection of the body of the pancreas was performed with a pancreaticogastrostomy for the distal pancreatic remnant. At histology, the diagnosis was that of a myxoid pancreatic liposarcoma with surgical margins that were free of tumor. After 44 months, a second operation was performed to remove a local recurrence, 4 x 3 cm in size. He is currently asymptomatic after 3 further months of follow-up. Liposarcomas are malignant neoplasms of adipose tissue. Histologically, the most common types are the well-differentiated liposarcoma, the myxoid liposarcoma and the dedifferentiated liposarcoma. These tumors largely develop in middle-aged or older individuals. Common sites for the dedifferentiated liposarcoma include the retroperitoneum and the spermatic cord. In contrast, well-differentiated and myxoid liposarcomas usually occur in subcutaneous and intramuscular sites and are uncommon in the retroperitoneum. Retroperitoneal liposarcomas, in particular, are often relatively large at the time of diagnosis and only rarely arise from the pancreas. The behavior of liposarcomas is strongly influenced by the histology such that the dedifferentiated liposarcoma is more likely to recur locally and metastasize. The most important factor influencing prognosis is the adequacy of surgical resection at the time of primary presentation. The CT scan illustrated above is typical of a liposarcoma with low density areas consistent with fat as well as thick septae of soft tissue. Dedifferentiated neoplasms have less fat and can have a similar appearance to other sarcomas. The differential diagnosis on imaging may also need to include benign lipoma, angiomyolipoma and malignant fibrous histiocytoma.

Choledochal cysts are congenital anomalies of the bile duct that result in dilatation of the extrahepatic bile duct, the intrahepatic bile ducts or both components of the biliary system. Although several forms of dilatation have been described including bile duct diverticula, the most common is diffuse dilatation of the extrahepatic bile duct. The majority of these patients also have an anomalous junction of the bile duct and main pancreatic duct creating a “long common channel”. At least 50% of patients are diagnosed before the age of 10 years because of abdominal pain, jaundice, pancreatitis or a palpable abdominal mass. However, 25% of patients present as adults, usually with abdominal pain, pancreatitis or abnormal liver function tests. The diagnosis is readily made on an ultrasound study but additional investigations can include computed tomography (CT) scans, magnetic resonance imaging (MRI) scans and endoscopic retrograde cholangiopancreatography. The treatment of choice is usually surgical excision of the cyst with a biliary reconstruction using a choledochojejunostomy. Complications of untreated choledochal cysts include biliary cirrhosis, portal hypertension and the development of cholangiocarcinoma. Complications after surgery can include a cystic bile duct remnant as illustrated below. The patient was a 48-year-old woman who was admitted to our hospital with upper abdominal pain. Her past history included excision of a choledochal cyst at the age of 8 years. She was investigated with an enhanced CT scan, MRI scan (T2 weighted) and magnetic resonance cholangiopancreatography (MRCP). The CT scan (Figure 1, left) and MRCP (Figure 1, right) show a cystic structure in the head of the pancreas with a filling-defect, 15 mm in diameter. Various tumor markers were within the reference range. At laparotomy, there was a dilated remnant of the bile duct in the head of the pancreas (Figure 2, left). This was resected down to the junction with the main pancreatic duct. The bile duct remnant contained a calculus (Figure 2, right) while histological examination of the wall of the sac only revealed chronic inflammatory tissue. The patient has been followed for 12 months since surgery and is currently painfree. The management of enlarged but asymptomatic bile duct remnants is less clear although there are case reports of the development of bile duct cancer.