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Bajaj AnubhaCorresponding author MD. (Pathology) Panjab University, Department of Histopathology, A.B. Diagnostics, A-1, Ring Road , Rajouri Garden, New Delhi, 110027, India.
Cutaneous ciliated cyst is cogitated as a benign, exceptional lesion and can be additionally termed as cutaneous Mullerian cyst or a cystadenoma. Cutaneous ciliated cyst was initially described by Da Hess in 1890 and further elucidated in 1978 by Farmer and Helwig as a cyst predominantly occurring in young females within the second and third decades of life 12. Cutaneous ciliated cyst is a lesion of post- pubertal females, can appear in the reproductive phase and frequently enlarges during menstruation or pregnancy due to hormonal effects. Cutaneous ciliated cyst is commonly situated within deep-seated dermal or subcutaneous tissue of the upper extremities and perianal region. Cutaneous ciliated cyst delineates as Mullerian derivation in females and a distinct, foetal eccrine duct origin in males 12.
A 69 year old female with a history of pancreatic mucinous cystadenoma (treated with Whipple procedure) and recently presumed liver cirrhosis presented to the hospital with melanotic stools. The source of the bleeding was initially thought to be secondary to upper gastrointestinal (GI) varices due to portal hypertension from the liver disease. Upper endoscopy found no active bleeding and confirmed grade 2 gastric varices with gastric wall edema. Due to persistent symptoms and inability to locate the exact source, she went to the operating room for possible transjugular intrahepatic portosystemic shunt (TIPS) but was not found to have any porto-systemic gradient. Instead, she was found to have an isolated stenosis of the left gastric vein, which was treated with balloon angioplasty and eventual splenectomy. Upper GI varices usually occur due to portal hypertension from liver disease. Extra hepatic causes are much rarer. We report a case of upper GI bleed from gastric varices secondary to left gastric vein stenosis rather than portal hypertension. The stenosis was due to a rare complication of a Whipple procedure. The case is unique as there are no reported cases of gastric varices secondary to left gastric vein stenosis.