Presentation
Incidental finding in the pancreas.
Patient Data
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CT scan showing a multiseptated low-density lesion in the pancreatic head measuring 3 cm in diameter with some central soft-tissue nodularity. There are no signs of pancreatic duct or biliary tree dilatation.
The imaged abdominal viscera are otherwise unremarkable.
No lymphadenopathy in the chest and abdomen.
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Multi septated low-density lesion in the pancreatic head seen on previous CT demonstrates high T2 signal in the multicystic component with no evidence of contrast enhancement or diffusion restriction. No wall thickening or nodularity. No connection to the pancreatic duct demonstrated. No pancreatic or common bile duct dilatation.
No focal lesions within the liver and spleen.
EUS: solid-cystic lesion at the head/uncinate process of the pancreas - microcystic appearance.
Case Discussion
The imaging features favor a pancreatic serous cystadenoma. A side branch IPMN is felt less likely given it is an isolated lesion with no communication with the pancreatic duct is seen.
The patient was then submitted to an EUS with FNA. The appearances on the ultrasound (not available) were typical for a serous cystadenoma. FNA:
- CEA: <5 ng/ml
- Ca19.9: 0.5 U/mL
Note that carcinoembryonic antigen (CEA) values are low in serous cystadenomas, like in this case. CEA values are elevated in mucinous lesions.
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