A Case of a Hepatic Epithelioid Hemangioendothelioma with Mucinous Cystadenoma of the Pancreas, that was Difficult to Diagnose Preoperatively

― A 64-year-old woman with a cystic lesion in the pancreatic tail, which had been detected by abdominal ultrasonography during a routine medical examination, was followed up due to a lack of obvious signs of malignancy. A year later, she underwent magnetic resonance cholangiopancreatography (MRCP) and was referred to our hospital for further investigation under the suspected diagnosis of mucinous cystadenoma of the pancreas. Contrast-enhanced computed tomography showed a 4-cm cystic lesion in the pancreatic tail. Five tumors were detected in the posterior segment of the liver. FDG-PET/CT showed no abnormal FDG uptake in the cystic lesion of the pancreatic tail, except for two tumors in the liver (SUVmax 3.5/3.8). Although the pancreatic lesion showed no signs of malignancy, as metastatic liver tumors could not be ruled out for the liver lesion. Thus we decided to plan the op-erative procedure according to the result of the intraoperative pathological diagnosis. During the op-eration, two parts of the partial resection of the liver, including the tumors, were cryo-sectioned for pathological examination, which revealed no signs of malignancy with unknown pathology. A distal pancreatectomy was then performed. Postoperative pathological examination showed pancreatic mucinous cystadenoma and hepatic epithelioid hemangioendothelioma.