Serous cystadenoma of pancreas

Serous cystadenoma of the pancreas (or microcystic adenoma) is an uncommon type of benign cystic pancreatic neoplasm

There is a recognised strong female predilection (M:F ~ 1:4) and usually presents in middle age to elderly patients (>60 years of age). 

Many patients are asymptomatic. Some may present with pain, weight loss, jaundice or a palpable mass 4,5.

Pancreatic serous cystadenomas are benign neoplasms composed of numerous small cysts that are arrayed in a honeycomb-like formation. There can be significant variation in locule size (1-20 mm) 2-4

Most individual cysts are typically <10 mm 12.

Three morphological patterns have been described 1:

  • polycystic: 70%
  • honeycomb: 20%
  • oligocystic (macrocystic variant): <10% (cysts can be larger than 20 mm)

The cysts are lined by glycogen-rich flat or cuboidal epithelium separated by fibrous septa that radiate from a central scar, which may be calcified. Lesions can be rather large at presentation (~5 cm). 

Associations
Location

Lesions favour the pancreatic head.

Plain radiograph
  • nonspecific and will usually be normal
  • may demonstrate amorphous central calcification overlying the pancreas
Ultrasound
  • nonspecific hypoechoic mass in the pancreatic head region, possibly with internal echoes indicating microcysts (the oligocystic subtype may demonstrate individually identifiable cysts 5)
CT 
  • typically demonstrates a multicystic, lobulated mass in the pancreatic head sometimes described as a 'bunch of grapes'
  • the individual cysts are typically <20 mm in size and greater than six in number (except for the oligocystic variety
  • a characteristic enhancing central scar may be present which can show associated stellate calcification (present in ~20% of cases)
MRI

Serous cystadenomas usually appear as a cluster of small cysts within the pancreas. There is no visible communication between the cysts and the pancreatic duct. 

Signal characteristics include

  • T1: typically low signal
  • T2: the central fibrous scar (if present) is low signal while cystic components themselves are high signal
  • T1 C+ (Gd): fibrous septa between them may enhance on delayed contrast enhanced images

Excluding the absence of communication with the main pancreatic duct, visualisation of the lesion will not be facilitated by secretin enhanced MRCP (SMRCP or MRCP-S) 14-15.

Angiography
  • may show enhancement due to hypervascular components 4

Most lesions are observed without treatment 5. They are benign lesions and do not recur once resected 4.

General imaging differential considerations on cross sectional imaging include


Pancreatic pathology
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Article Information

rID: 8290
Section: Pathology
Synonyms or Alternate Spellings:
  • Serous cystadenoma of the pancreas
  • Pancreatic serous cystadenoma
  • Microcystic adenoma of pancreas
  • Microcystic adenoma of the pancreas
  • Serous cystadenomas of pancreas
  • Serous cystadenomas of the pancreas

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