Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

ABDOMINAL
Year
: 2005  |  Volume : 15  |  Issue : 4  |  Page : 437--438

Microcystic adenoma of pancreas


S Shivram, A Nagar, R Uppal, H Karmalkar, S Phatak 
 15-B Ratlam Kothi, Kanchan Bagh Main Road, Indore-452001, India

Correspondence Address:
S Shivram
Consultant Radiologist, Medwin Diagnostics, 15-B Ratlam Kothi, Kanchan Bagh Main Road, Indore-452 001
India




How to cite this article:
Shivram S, Nagar A, Uppal R, Karmalkar H, Phatak S. Microcystic adenoma of pancreas.Indian J Radiol Imaging 2005;15:437-438


How to cite this URL:
Shivram S, Nagar A, Uppal R, Karmalkar H, Phatak S. Microcystic adenoma of pancreas. Indian J Radiol Imaging [serial online] 2005 [cited 2020 Dec 3 ];15:437-438
Available from: https://www.ijri.org/text.asp?2005/15/4/437/28767


Full Text

 INTRODUCTION



Cystic neoplasms of pancreas are less common accounting for about 10-15% of all cystic pancreatic lesions The two common cystic tumors of pancreas are serous Cystadenomas and mucinous cystic neoplasms. They are thought to arise from the ductal epithelium. The Pancreatic serous cystadenomas are also referred to as microcystic adenoma or glycogen rich cystadenoma is the benign type. The mucinous cystic neoplasm ranges from pre malignant to malignant. Therefore an attempt to distinguish these entities is important. We present one such case of microcystic adenoma of pancreas.

 CASE REPORT



Patient background; 55 year old woman hypertensive , non diabetic presented with a two day history of severe pain in the right upper quadrant of abdomen and vomiting. Blood examinations including Serum amylase and S. lipase on admission were within normal limits except for a marginal leukocytosis (11,800/cu mm). Patient was managed conservatively. A vague lump could be palpated on the second day of admission. US examination on the same day revealed an approximately 6.0cms mass involving the pancreatic head region pushing the portal vein anteriorly. There was no associated biliary or pancreatic duct dilatation. A subsequent CT scan of abdomen showed the mass to be of non homogenous nature also showing few septae and a central area of calcification. The mass reached up to the GB fossa. A near total excision of the tumor was performed(the pancreatic head was not resected completely) along with cholecystectomy . Pathological examination revealed a soft tissue mass attached to GB. Cut section revealed spongy congested tissue in pancreatic area with evidence of fibrosis. Microscopic examination revealed large dilated cystic channels few of them showing RBCs in the lumen. Some of the cystic spaces showed lining of cuboidal cells. Features were suggestive of Microcystic Adenoma of Pancreas.

 DISCUSSION



Cystic tumors make up around 5% of all pancreatic neoplasms and usually occur in females between 30 -60 yrs of age. These tumors remain clinically silent and are therefore fairly large in size at the time of presentation. They average from 5-8cms in size (range 4-20cms)[1]. Biliary obstruction is rare and the symptoms are usually non specific usually related to the mass effect. Smaller tumors may be incidenatlly detected on CT and USG examinations

CT scan is the superior examination in lesion depiction and characterization and it is the preferred imaging modality . The first test performed however is usually Ultrasonography because the typical presenting symptom is abdominal pain and or nausea.

Radiographic differentiation can be attempted on the basis of mass size calcification and number of cysts.[2]. The lesions have a mean diameter of 5-8cms with a lobulated external contour[3]. Microcystic adenomas are usually composed of cysts measuring less than 20mm in diameter and commonly greater than six in number. In USG examination the cluster of grapes and lobulation may be observed the mass may appear echogenic and solid because of large number of acoustic interfaces . Imaging wise differential diagnosis would include Pancreatic carcinoma, lymphoma, focal pancreatitis ,Pseudocyst etc.

Histologically Cystadenomas are characterized by microcystic architecture lined by cuboidal epithelium .The cytoplasm contains glycogen which can be demonstrated with periodic Schiff acid stain and confirmed with amylase. A recent case report has however suggested microcystic adenomas having malignant potential thus reintroducing the debate whether complete surgical excision is necessary at the time of diagnosis[4].

References

1Robbins Pathological Basis of Disease. Contran Jumar and Collins 6th edition. W.B.Saunders Company, 1999, 909-910.
2Diagnostic Radiology. An Anglo. American Textbook of Imaging. Granger and Allison. 2nd edition. Churchill Livingstone, 1997, 1133-1145.
3Clinical Imaging: An Atlas of Differential Diagnosis. Eisenberg 3rd Edition. Lippincott. Raven publishers, 1997, 522-531
4Serous Cystadenoma of the Pancreas with Invasive Growth. Benign or Malignant ?. Abe, Kubota, Mori, Miki, Minangawa, Noie, Kimura, Makuuchi. American Journal of Gastroenterology. 1998, Vol. 93 (10).