The role of diagnostic laparoscopy in finding the origin of large left upper quadrant cysts compared with imaging techniques, a case report, and review of literature

Left Upper Quadrant (LUQ) cysts are often discovered by accident. Due to the lack of specific methods for the definitive diagnosis of premalignant lesions, the management of LUQ cysts is of great importance. In this regard, Awareness of differential diagnoses (such as adrenal and pancreatic cysts), the use of imaging techniques, and surgical indications are very important.

A 56-year-old woman with a history of the left adrenal cyst was referred to the Department of Surgery for LUQ pain after eating. Abdominal ultrasound and CT scan showed a 120 mm cystic lesion of the left adrenal gland. The patient was a candidate for laparoscopic surgery. During surgery and contrary to the initial diagnosis, a large cyst about 150 mm in the tail of the pancreas was detected by the involvement of the splenic vein and artery. Distal pancreatectomy and splenectomy were performed. Pathological examination revealed a mucinous tubulopapillary neoplasm with high-grade dysplasia along with an undifferentiated pancreatic carcinoma that was as small as 5 mm.

Current imaging techniques are not able to pinpoint the origin of large LUQ cysts, which can lead to errors in the management of malignant lesions of the pancreas or adrenal. Therefore, it seems that the use of the laparoscopic method not only has advantages such as less pain, reduced hospitalization period, and faster return to daily activities but also can help make the correct diagnosis during surgery and allow the surgeon to make the right decision.