Tumors of the pancreas that contain substantial cystic components include mainly mucinous cystic neoplasm, intraductal papillary mucinous neoplasm, solid pseudopapillary tumor, and cystadenomas (which encompass microcystic, macrocystic/oligocystic, and rare solid serous adenomas). Microcystic adenoma of the pancreas is a tumor that is benign in nature. Malignant transformation in the tumor with metastases is rare and only about 26 cases have been reported so far. Here we present a giant microcystic adenoma of the pancreas, possibly the largest ever malignant type in this group ever reported in the literature with extensive metastases to the liver and causing extensive compression and encasement on surrounding structures. 1. Introduction Pancreatic cystic tumors fall into the serous or mucinous category. The latter most prominently shows malignant transformation in the long run, while the former is considered benign [1]. Microcystic adenoma of the pancreas is a rare tumor that presents indolently with features of slow growth and abdominal pain secondary to mass effect. These tumors are managed expectantly and surgical management is considered only when the patient becomes symptomatic [2]. The mucinous cystadenomas on the other hand, even though slow growing, have high chances of malignant transformation and hence need to be managed earlier, surgically [3]. Malignant transformation of cystic adenomas of the pancreas was first described in 1989 wherein the tumor showed invasion into surrounding structures and into the liver [4]. Afterwards, about 26 case reports and reviews have been inculcated into the literature on cystadenocarcinomas [5]. Characterization of benign cystic adenomas from cystadenocarcinomas has been extremely difficult. The presence of histological invasion is the only modality that can differentiate these two conditions [6]. One recent case report by Zhu et al. revealed for the first time carcinoma ex microcystic adenoma in which the tumor, without metastases, showed inherent malignant changes [7]. Of all the cystadenocarcinomas reported, our report is unique in three aspects. Firstly, this is the largest cystadenocarcinoma reported in the literature. Secondly, the radiological appearance of the tumor is that of a “parasite mass” that takes up extensive blood supply from the celiac axis, and lastly the tumor extensively involved surrounding structures, notably the biliary tree, producing features of obstructive jaundice, a feature never reported before. 2. Case Report A 70-year-old woman, hailing from Kashmir in India, presented to us
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