Triple threat: pancreatic cystic lesion presenting with spontaneous hemorrhage is found to harbor three distinct neoplasms

Abstract Background Pancreatic serous cystadenoma (SCA) is a benign, cystic lesion with an indolent growth pattern. Complications such as spontaneous hemorrhage or malignant transformation from SCA are extremely rare. Our case report describes unusual presentation of patient previously diagnosed SCA, made unique by the presence three separate neoplasms in final specimen. Case A 74-year-old male previous diagnosis presented emergently epigastric pain and non-bilious vomiting. Laboratory results were notable for hemoglobin 8.3 g/dl. CT scan abdomen demonstrated complex, solid-cystic mass pancreatic head large hematoma questionable focus active hemorrhage. Surgical resection was recommended due to risk malignancy, possibility re-bleeding, symptoms severe duodenal compression. Pancreaticoduodenectomy performed, pathology neoplasms: cystadenoma, intraductal papillary mucinous neoplasm, neuroendocrine tumor. Conclusion While benign tumors that can be observed safely majority cases, surgical intervention often indicated patients large, symptomatic cysts when unclear. When undergoing surveillance, it crucial both care team aware rare, but life-threatening complications, Likewise, misdiagnosis concurrent neoplasia should considered.