Serous cystadenoma of the pancreas, also referred as microcystic adenoma, is an uncommon type of benign cystic pancreatic neoplasm.
There is a recognized 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).
- von Hippel Lindau (vHL) disease: can be multiple or diffuse and present at a younger age
Lesions favor the pancreatic head.
- nonspecific and will usually be normal
- may demonstrate amorphous central calcification overlying the pancreas
- nonspecific hypoechoic mass in the pancreatic head region, possibly with internal echoes indicating microcysts (the oligocystic subtype may demonstrate individually identifiable cysts 5)
- 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)
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
- may show enhancement due to hypervascular components 4
Treatment and prognosis
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:
- intraductal papillary mucinous tumor (IPMN) of the pancreas: communicates with pancreatic ducts
- pancreatic pseudocyst
mucinous cystic neoplasm of the pancreas (e.g. mucinous cystadenoma)
- calcification tends to be peripheral
- usually unilocular
- if multilocular type, individual cysts tend to be >20 mm in size
- solid pseudopapillary tumor with cystic changes and necrosis 16
- 1. Choi JY, Kim MJ, Lee JY et-al. Typical and atypical manifestations of serous cystadenoma of the pancreas: imaging findings with pathologic correlation. AJR Am J Roentgenol. 2009;193 (1): 136-42. doi:10.2214/AJR.08.1309 - Pubmed citation
- 2. Kim HJ, Lee DH, Ko YT et-al. CT of serous cystadenoma of the pancreas and mimicking masses. AJR Am J Roentgenol. 2008;190 (2): 406-12. doi:10.2214/AJR.07.2808 - Pubmed citation
- 3. Cohen-scali F, Vilgrain V, Brancatelli G et-al. Discrimination of unilocular macrocystic serous cystadenoma from pancreatic pseudocyst and mucinous cystadenoma with CT: initial observations. Radiology. 2003;228 (3): 727-33. doi:10.1148/radiol.2283020973 - Pubmed citation
- 4. Genevieve L. Bennett et.al, Radiologic-Pathologic Conferences of the Massachusetts General Hospital Serous Cystadenoma of the Pancreas , AJR 1993;161:786
- 5. Buck JL, Hayes WS. From the Archives of the AFIP. Microcystic adenoma of the pancreas. Radiographics. 1990;10 (2): 313-22. Radiographics (abstract) - Pubmed citation
- 6. Yeh HC, Stancato-pasik A, Shapiro RS. Microcystic features at US: a nonspecific sign for microcystic adenomas of the pancreas. Radiographics. 21 (6): 1455-61. Radiographics (full text) - Pubmed citation
- 7. Khurana B, Mortelé KJ, Glickman J et-al. Macrocystic serous adenoma of the pancreas: radiologic-pathologic correlation. AJR Am J Roentgenol. 2003;181 (1): 119-23. AJR Am J Roentgenol (full text) - Pubmed citation
- 8. Sahani DV, Kadavigere R, Saokar A et-al. Cystic pancreatic lesions: a simple imaging-based classification system for guiding management. Radiographics. 25 (6): 1471-84. doi:10.1148/rg.256045161 - Pubmed citation
- 9 .Buetow PC, Rao P, Thompson LD. From the Archives of the AFIP. Mucinous cystic neoplasms of the pancreas: radiologic-pathologic correlation. Radiographics. 18 (2): 433-49. Radiographics (abstract) - Pubmed citation
- 10. Itai Y, Ohhashi K, Furui S et-al. Microcystic adenoma of the pancreas: spectrum of computed tomographic findings. J Comput Assist Tomogr. 12 (5): 797-803. - Pubmed citation
- 11. Dewhurst CE, Mortele KJ. Cystic tumors of the pancreas: imaging and management. Radiol. Clin. North Am. 2012;50 (3): 467-86. doi:10.1016/j.rcl.2012.03.001 - Pubmed citation
- 12. Kalb B, Sarmiento JM, Kooby DA et-al. MR imaging of cystic lesions of the pancreas. Radiographics. 2009;29 (6): 1749-65. Radiographics (full text) - doi:10.1148/rg.296095506 - Pubmed citation
- 13. Macari M, Megibow AJ. Focal cystic pancreatic lesions: variability in radiologists' recommendations for follow-up imaging. Radiology. 2011;259 (1): 20-3. doi:10.1148/radiol.11102437 - Pubmed citation
- 14. Iannicelli E, Carbonetti F, Di Pietropaolo M et-al. Magnetic resonance cholangiopancreatography with secretin stimulation in the diagnosis of intraductal papillary mucinous neoplasm: a paradigmatic case report. Case Rep Radiol. 2014;2014: 820359. doi:10.1155/2014/820359 - Free text at pubmed - Pubmed citation
- 15. Purysko AS, Gandhi NS, Walsh RM et-al. Does secretin stimulation add to magnetic resonance cholangiopancreatography in characterising pancreatic cystic lesions as side-branch intraductal papillary mucinous neoplasm?. Eur Radiol. 2014;24 (12): 3134-41. doi:10.1007/s00330-014-3355-y - Pubmed citation
- 16. Kim HJ, Lee DH, Ko YT,et al. CT of serous cystadenoma of the pancreas and mimicking masses. (2008) AJR. American journal of roentgenology. 190 (2): 406-12. doi:10.2214/AJR.07.2808 - Pubmed
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