Indian Journal of Radiology Indian Journal of Radiology  

   Login   | Users online: 1599

Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size     

 

ABDOMINAL Table of Contents   
Year : 2005  |  Volume : 15  |  Issue : 4  |  Page : 439-441
Pancreatic serous cystadenoma - a case report.


Department of Radio-Diagnosis, Dr. S.N. Medical College and Associated Group of Hospitals, Jodhpur (Rajasthan), India

Click here for correspondence address and email
 

Keywords: Pancreas, Epigastric, Cystic

How to cite this article:
Sabharwal K K, Chouhan A L, Saxena M K. Pancreatic serous cystadenoma - a case report. Indian J Radiol Imaging 2005;15:439-41

How to cite this URL:
Sabharwal K K, Chouhan A L, Saxena M K. Pancreatic serous cystadenoma - a case report. Indian J Radiol Imaging [serial online] 2005 [cited 2020 Oct 30];15:439-41. Available from: https://www.ijri.org/text.asp?2005/15/4/439/28768

   Introduction Top


The spectrum of cystic neoplasms of the pancreas encompasses a wide range of histologies from benign to malignant. The majority of cystic masses of the pancreas, excluding pseudocyst, will be either mucinous cystic neoplasm (macrocystic adenoma) or serous cystadenoma (microcystic adenoma). The most common group of cystic neoplasms are mucinous family, benign and malignant. Next in frequency are the serous cystadenomas, often called microcystic adenomas because of the numerous small locules that characterize their morphology. These are almost invariably benign.


   Case Report Top


A 38 yrs. old female patient presenting with complaints of pain abdomen in epigastric region with lump in mid upper abdomen. Routine hematological investigations revealed, Hb 10gm/dl, TLC 5000/mm3, DLC (N 56, L 40, M 3, E 1, B0), ESR 10mm/h, blood sugar (fasting) 75 mg/dl, serum amylase 120 U/L.

Ultrasound showed a well-defined, multi loculated, cystic mass of size 7.7 x 5.3 cm. with internal septations, in the head region of pancreas, completely replacing the normal pancreatic tissue [Figure - 1].

The largest cystic space measuring 13.2 x 12.0 cm, seen in body and tail region [Figure - 2].

Contrast enhanced CT scan showed a large, well-defined, multi loculated, mixed solid and cystic mass of size 8.0 x 5.5 cm, showing enhancing internal septations and cyst walls, producing a typical swiss cheese or honey-combing appearance, in head region of pancreas, completely replacing the normal pancreatic tissue. Foci of punctate and ring like calcifications, seen in mass lesion [Figure - 3].

The largest cystic space measuring 14.0 x 10.1 cm, showing foci of capsular calcification, involving body and tail region, effacing the posterior wall of stomach [Figure - 4].

Follow up:-

After complete investigations, patient was diagnosed as a case of cystic neoplasm of pancreas. After pre-operative preparation, she was posted for exploration of epigastric lump. Intra-operatively, the whole of pancreas was studded with multiple cysts of various sizes, completely replacing the normal pancreatic parenchyma.

Aspiration of cysts yielded clear fluid. Plane was developed between body of pancreas anteriorly and splenic vein posteriorly upto portal vein and then distal 2/3 of pancreas was resected and remaining stump of pancreas was cauterised.

Histology of resected pancreatic tissue reveals multi cystic lesion. The cysts are variable in size and are lined by cuboidal cells and supported by myo epithelial cells at places. The coboidal cells have PAS positive cytoplasm (Glycogen rich). Pancreatic ducts and atrophic acini are present in the cyst walls at places.


   Discussion Top


About 94% of exocrine epithelial tumors of pancreas are ductal adeno-carcinoma. The remaining 6% is constituted by solid pseudo papillary, serous cystic and mucin producing forms [1]. The neoplastic cysts of pancreas are estimated to account for at least 10% of pancreatic cysts [2]. The most common group of cystic neoplasms are the mucinous family, benign and malignant. Next in frequency are the serous cystadenomas, often called microcystic adenomas because of the numerous small locules that characterize their morphology [2]. Although only 400 cases of serous cystadenomas have been reported in the literature, there has been an increased recognition of this lesion in recent years [2]. They are seen almost exclusively after 35 years of age and 82% occurs after 60 years of age [2]. There is strong female predominace with a sex ratio of 2:1[2]. The most common presenting symptom is vague abdominal pain. A palpable epigastric mass is present in nearly two third of cases [2].

Serous cystadenomas are generally solitary lesions, although rarely multiple cysts may be present. Many of them are located in head of pancreas. They average 7 cm. in diameter, with ranges from 1 to 25 cm reported [2].

Sonographically, the lesions may appear as solid echogenic mass secondary to myriad of interfaces produced by the numerous microscopic cysts, or may appear as a multilocular cyst or a mixed solid and cystic lesion[3],[6].

On Unenhanced CT, they appear as hypodense, near water attenuation masses that frequently show calcifications [6]. A central stellate scar that may calcify is seen in upto 20% of cases [6]. The tumor is hypervascular and contrast enhancement of septations results in a typical "Swiss Cheese" or honey combing appearance due to the presence of multiple tiny cysts [4],[6].

Radiological differentiation of these neoplastic cystic lesions is from pseudocyst, in a unilocular lesion. In the proper clinical setting, the absence of radiological signs of acute or chronic pancreatitis, presence of solid component in cystic mass, and lack of communication of the cysts with main pancreatic duct on ERCP, favors the diagnosis of cystic neoplasm [4],[6].

Differential diagnostic features that help in distinguishing serous from mucinons cystic tumours include older age group, and presence of multiple (>6) cysts, measuring less than 2 cm in diameter [4],[6]. Fishman et al reported that CT and Sonography can correctly distinguish mucinous from serous cystadenomas, in approximately 90% of cases [5]. Lesion enhancement particularly in septas is characteristic of microcystic (serous cystadenoma) where as enhancement of tumour nodules are typical of mucinous cystic neoplasms [4],[5],[6].

Pathologically, these tumors are generally spherical or ovoid with a smooth glistening surface. On cut section, most are composed of multiple smaller cysts containing clear fluid that gives a tumour a honeycombed appearance [2]. Microscopically multiple cystic spaces are lined by cuboidal epithelium. The cytoplasm in these cells is rich in glycogen [2]. Mucin is not present. Intermediate varieties of cystadenomas with features of both micro cystic adenoma and mucinous cystadenomas occasionally are encountered, making diagnosis less definitive than currently stated in the literature [2].

 
   References Top

1.Kloppel G, Bogomoletz WV: Tumours of exocrine pancreas. In: Diagnostic histopathology of tumour. Fletcher CDM ed 2nd London: Churchill Livingstone, 2000: 461 - 474.  Back to cited text no. 1    
2.Warshaw, Castillo, Rattner DW et al: Pancreatic cysts, pseudocysts, and fistulas. In: Maingot's Abdominal operations, Volume II, Tenth edition: Mc Graw Hill, 2001: 1920 - 1921.  Back to cited text no. 2    
3.David Cosgrove: Microcystic, adenoma of Pancreas. In: clinical ultrasound, a comprehensive text, Volume I, 2nd edition, 2001: 374-375  Back to cited text no. 3    
4.Hagga JR: Cystadenoma Pancreas. In: CT and MR imaging of whole body, Volume II, 4th edition, 2003: 1471-1474.  Back to cited text no. 4    
5.Sheth S, Fishman EK: Imaging of uncommon tumours of the pancreas. Radiol clin N Am 40: 2002, 1273-87.  Back to cited text no. 5    
6.Berry M, Chowdhury V: Tumours of the pancreas. In: diagnostic radiology. Gastrointestinal and hepatobiliary imaging, 2nd edition: Jaypee Publication, 2004: 373-375  Back to cited text no. 6    

Top
Correspondence Address:
K K Sabharwal
C-86, Shastri Nagar, Jodhpur (Rajasthan)
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.28768

Rights and Permissions


    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  


    Introduction
    Case Report
    Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed4156    
    Printed102    
    Emailed0    
    PDF Downloaded223    
    Comments [Add]    

Recommend this journal