In addition, serous cystic neoplasms slowly grow, and if they grow large enough they can press on. We report a 47yearold woman with macrocystic serous cystadenoma of the pancreas. Cuboidal cells with watery clear cytoplasm due to glycogen, with round dense nuclei but no atypia. Macrocystic serous cystadenoma of the pancreas springerlink. Among lesions that are not pseudocysts, serous cystadenoma, mucinous cystic. Serous cystadenoma of the pancreas with atypical clinical. Solid serous microcystic adenoma of the pancreas world. Case report we report the case of a 52yearold woman admitted to our hospital who had suffered from epigastric pain, nausea and vomiting for 4 months. Serous cystadenomas of pancreas are rare benign epithelial neoplasms, which predominantly occur in the pancreatic body and tail of elderly females. Serous cystadenoma sca represents a form of pancreatic cystic neoplasm which accounts for 1015% of pancreatic tumors and is characterized by benign behavior and heterogeneous macroscopic features, although the microscopic structure of pancreatic sca is uniform, the macroscopic feature shows a wide heterogeneity. The purpose of our study was to determine useful ct criteria for differentiating serous oligocystic adenomas of the pancreas from other similarly presenting neoplasms, such as mucinous cystadenoma and intraductal papillary mucinous tumor of the branch duct type. A disseminated variant of pancreatic serous cystadenoma.
Characterization of cystic pancreatic neoplasms by computed. Serous cystadenoma of the pancreas is a rare lesion thought to be almost invariably benign. Cystic lesion is well demarcated from adjoining pancreas by small fibrous band containing some vessels. Pancreatic serous cystadenoma with compression of the main.
This study examines the cytology, clinical and radiologic features, diagnostic accuracy of fineneedle aspiration fna, and potential pitfalls. Cystic neoplasms of the pancreas are less common, accounting for about 1015% of all cystic pancreatic lesions. It can affect both males and females, though females are affected more 6580% of the cases involve women. Ct of pancreatic serous cystadenoma hepatobiliary imaging pictorial essay. These neoplasms are almost exclusively benign tumors, and rarely become malignant. Serous cystic neoplasms of the pancreas although they carry a realistic risk of malignancy, the predominant view is that they never become malignant. Serous microcystic adenoma of the pancreas surgical. Serous cystadenoma of the pancreas is a diagnosis being entertained with increasing frequency. Majority occurs in the body and tail, although 30% of the time they are seen in the head. Combined welldifferentiated endocrine neoplasmserous cystadenoma. In this paper, we present the rare case of a serous cystadenoma of the pancreas causing obstruction and upstream dilatation of the main pancreatic duct, making difficult the differential diagnosis with ipmt. Diffuse pancreatic serous cystadenoma associated with.
Serous cystadenoma of the pancreas, also referred as microcystic adenoma, is an uncommon type of benign cystic pancreatic neoplasm. There is some acellular fibrous tissue with a variable degree of hyalinization and edematous change in the stroma. Microcystic adenoma or serous cystadenoma sca is an uncommon tumor type, accounting for only 12% of pancreatic exocrine neoplasms. A 54year old female was admitted for recurrent bouts of central abdominal pain radiating to back since last 6 months. Serous cystadenomas of the pancreas have a wide range of ct findings. Ringlike enhancement due ct of serous cystadenoma of the pancreas and mimicking masses hyoung jung kim1 dong ho lee1 young tae ko1 joo won lim1. Serous cystadenoma of pancreas occur in adults in the age group of 2590 years, with average age of presentation being 60 years. T2 potentials and pitfalls of a preoperative cytopathologic diagnosis.
These are uncommon tumors and constitute about 12% of all pancreatic tumors. Sometimes larger cysts are mixed in with many small ones, raising concern for a pancreatic pseudocyst or some other cystic tumor of the pancreas such as mucinous cystadenoma or cystadenocarcinoma. Among this group of lesions, the serous cystadenoma is typically asymptomatic. If there are no signs and symptoms, then a wait and watch approach has been recommended by some experts, since it is a benign condition. The most common presentation is with numerous small cysts that give a honeycomb appearance microcystic variant, thin septa, and sometimes with a central scar. They can be divided into serous and mucinous subtypes, with the former behaving less aggressively and generally considered benign. All patients are alive for 18 to 81 months after surgery. Since 1978, 211 cases have been reported in the literature. Serous cystadenoma is a common benign neoplasm that can be managed without surgery in asymptomatic patients provided that the diagnosis is certain. Serous cystadenomas were not established as an independent clinical or pathological cystadenoma until 1978 when the unique nonmucinous epithelial features.
Cystic neoplasms of the pancreas are less common than solid tumors, and portend a better prognosis. Ct of serous cystadenoma of the pancreas and mimicking masses. Cystic neoplasms of the pancreas include serous cystic tumors, mucinous cystic neoplasms, solid pseudopapillary neoplasms, cystic islet cell tumors, and intraductal papillary mucinous neoplasms of the pancreas ipmns. Serous cystadenoma definition of serous cystadenoma by. Combined serous cystadenoma and pancreatic endocrine. Spontaneous rupture of mucinous cystadenoma of the pancreas atindriya biswas and satyajit bhattacharya department of surgery, the royal london hospital, london, uk corresponding address. Pancreatic serous cystadenoma is a benign tumour of pancreas. Diagnostic criteria, potential for growth or malignancy, and outcomes are not. Cystadenoma and cystadenocarcinoma of the pancreas. Various pathological entities of pancreas may present with radiological diagnosis of cystic lesions, including benign, borderline, and malignant.
The histopathologic findings, diagnostic strategy, differential diagnosis, and treatment strategy of. Of the serous neoplasms, serous microcystic adenoma is the most common. Serous cystadenoma of pancreas is an uncommon benign tumor of the pancreas that forms as a cyst. Majority of these tumors have microcystic appearance. During the period 1987 to 1994, 14 patients with cystic neoplasms of the pancreas were surgically treated.
In contrast to some of the other cystforming tumors of the pancreas such as the intraductal papillary mucinous neoplasm and the mucinous cystic neoplasm, serous cystic neoplasms are almost always entirely benign. Serous cystadenoma of pancreas is a benign tumor of pancreas. Giant pancreatic serous cystadenoma necessitates surgical resection due to large size, symptoms, uncertain diagnosis, and adjacent organ. The preoperative diagnosis of pancreatic serous cystadenoma sca is important because as a typically benign tumor it can be treated expectantly, whereas many other cystic tumors require excision. In contrast to some of the other cystforming tumors of the pancreas, serous cystic neoplasms are almost always entirely benign. The two most common cystic neoplasms of the pancreas are serous cystadenoma and mucinous cystic neoplasms. Serous cystadenoma of the pancreas is the most common benign pancreatic neoplasm. N2 serous cystic tumors of the pancreas are unique among pancreatic cystic neoplasms in that they are almost always cytologically monomorphous and biologically benign. Serous cystadenomas are the most common type of cystic neoplasm of the pancreas 5. The morphologic and immunohistochemical features are consistent with pancreatic serous cystadenoma. We report a case of incidentally detected pancreatic hc combined with a serous microcystic cystadenoma, in a 47.
Cystadenomas and cystadenocarcinomas of the pancreas ncbi. Usually unifocal, scas present as single, large, welldemarcated, multiloculated, cystic tumors, 125 cm in size. Ipmns have also been referred to as mucinous duct ectasias and intraductal papillary mucinous tumors. But diagnostic difficulties may be encountered in the macrocystic oligocystic form of serous cystadenoma seen in 10% to 30% of cases 4, 5. Pancreatic cystic lesions with increasing advances imaging and asymptomatic cystic tumors of the pancreas has increased than are described prevalence in the. Laparoscopic pancreatic procedures are under evaluation. The full text of this article is available in pdf format. Computed tomographic and magnetic resonance mr images showed a hypervascular solid tumor that was difficult to differentiate from endocrine tumor of the pancreas. Pancreatic serous cystadenomas are rare benign cystic neoplasms. Ultrasonography and computed tomography revealed a unilocular cyst in the body of the pancreas. Pathologically, two patients 29% had serous, and five 71% mucinous, cystadenoma.
It typically occurs in women most tumors do not cause any signs and symptoms, but in some individuals, there may be abdominal pain, indigestion, and loss of appetite due to serous cystadenoma of pancreas. Mucinous cystadenoma of the pancreas associated with. The similarities stem from the bland architecture of the lesions, and noncommunicating cysts of different sizes compressing the surrounding benign pancreatic stroma. Serous cystadenoma of pancreas is a rare benign cystic neoplasm constituting 12% of all exocrine pancreatic tumors and isnt it 1015% of all cystic pancreatic neoplasms. Management of serous cystic adenoma of the pancreas. Serous cystadenoma of the pancreas with atypical clinical manifestations. Pdf serous cystadenoma of the pancreas researchgate. There are only two previous case reports of a mucinous cystadenoma causing acute pancreatitis1, 2 and two case reports of the coexistence of a pancreatic pseudocyst with a mucinous cystadenoma.
Ct of serous cystadenoma of the pancreas and mimicking. Context the presence of a combined serous cystadenoma and pancreatic endocrine neoplasm is a distinct clinicopathological entity rather than the incidental concurrence of two separate entities. Ct and mri showed a 10 cmpolycystic tumor with upstream dilatation of the. We report a case of solid type serous cystadenoma of the pancreas. Serous cystic tumors of the pancreas arizona state.
Pdf management of serous cystadenoma of the pancreas. Surgical treatment of pancreatic serous cystadenoma. We report a case, which, according to our best knowledge is the 27th case reported in the literature. Diagnostic criteria, potential for growth or malignancy, and outcomes are not well defined. Serous cystadenoma of pancreas radiology reference. This cystic neoplasm is made up of several small cysts spread into a honeycomb like appearance. Extended operations are unnecessary for serous cystadenomas and minimally invasive surgery should be performed. Serous microcystic adenoma of the pancreas navigation for this section. Pancreatic hepatoid carcinoma hc is an extremely uncommon neoplasm of pancreas that resembles hepatocellular carcinoma hcc.
An extremely rare solid variant of serous microcystic adenoma lacking secretory. Unlike small islet cell tumors, which show strong homogeneous en hancement during the pancreatic phase, large islet cell tumors often show heterogeneous enhancement 10. Mr s bhattacharya, consultant surgeon, hepatobiliary and pancreatic surgery unit, the royal london hospital, whitechapel road, london e1 1bb, uk. She had no past history of abdominal surgery, instrumentation, or trauma. Accounts for almost 50% of pancreatic cystic neoplasms. Mucinous cystic neoplasms should be resected because of the risk of malignant progression. The histogenesis of mixed tumors within the pancreas. However, the tumor showed marked hyperintensity similar to that of hepatic cyst on mr cholangiopancreatography, indicating not a solid but rather a. Familiarity with the varied ct appearances and awareness of the diagnostic limitations of ct are important for accurate diagnosis and management of serous cystadenoma of the pancreas. We describe a patient, whose pancreatic cyst exhibited a radiological appearance distinct from that of typical serous cystadenoma, resulting in diagnostic difficulties. Three cases of pancreatic serous cystadenoma and endocrine. Pancreatic serous cystadenoma is typically found in women accounting for 74% of cases with a mean age of 58 years 1699 years, and the tumor is usually located at the bodytail of the pancreas.
The treatment measures available for benign mucinous cystadenoma of pancreas include the following. A 73yearold man initially presented with epigastric abdominal pain and was diagnosed with sca involving the whole pancreas. Neoplasm and intraductal papillary mucinous neoplasm ipmn are the most. Differential diagnosis of pancreatic serous cystadenoma and. Serous cystadenoma is more common than mucinous cystic neoplasm, with a ratio of about 2. Pancreas, serous cystadenoma, computed tomography, pancreatic cysts.
Laparoscopic resection of a pancreatic serous cystadenoma. The pancreatic serous cystadenoma is an epithelial neoplasm that mostly affects women with a slight predominance in the pancreatic head. Serous cystadenoma of pancreas is mainly present in women, especially over the age of. Spontaneous rupture of mucinous cystadenoma of the pancreas. Serous adenomas represent 12% of pancreatic neoplasms and typically are asymptomatic not requiring any treatment and simple observation is the option of choice. Although, they carry a realistic risk of malignancy despite the general view that they never become malignant. Immunohistochemically the tumor cells are positive with ema and muc1 while negative for hmb45. Hepatoid carcinoma of the pancreas combined with serous.
We present a case of a 79yearold greek woman with symptomatic cholelithiasis and a serous pancreatic cystadenoma located at the neck of. Macrocystic and solid variants have also been described. Background serous cystadenomas of pancreas are rare benign epithelial neoplasms, which predominantly occur in the pancreatic body and tail of elderly females. To define the natural history and optimal management of serous cystadenoma of the pancreas. The microcystic pattern, or polycystic pattern, is present in 12% of all exocrine pancreatic tumors and in 70% cases of serous cystadenomas, and consists of a collection of cysts usually more than 6 that range from a few millimeters up to 2 cm in size. Once thought to be rare, cystic neoplasms of the pancreas are being diagnosed with increased frequency because of improvements in pancreatic imaging 14. The natural history and malignant potential of serous cystadenomas differ significantly from that of other cystic neoplasms.
How is benign mucinous cystadenoma of pancreas treated. On magnetic resonance imaging, the cyst showed heterogeneous signal intensity on t1weighted images, and was. Serous cystadenoma is a benign pancreatic cystic neoplasm. Fineneedle aspiration of pancreatic serous cystadenoma.