Pancreatic serous cystadenoma

Case contributed by Dr Camille Janet Dunn

Presentation

3-day history of gradual onset upper right quadrant pain, not associated with food intake. Has subjective fevers. No history of pancreatitis. Nil other complaints

Patient Data

Age: 45 years
Gender: Female
MRI

A large multicystic lesion is noted involving within the pancreatic tail. Overall measures 53 mm, giving the appearance of serous cystic neoplasm. However, age and location are suggestive of a mucinous neoplasm.

Uncomplicated gallstones.

CT

A Complex multilocular cystic lesion in the pancreatic tail is noted with areas of dystrophic calcification related to the traversing septations (? primary pancreatic cystic neoplasm).

Umbilical hernia with inflammatory stranding - fat containing.

Multiple small intraluminal gallbladder densities (? gallstones/sludge or polyps).

Case Discussion

Due to advances in medical imaging and increased used of abdominal scan, the number of incidental findings of pancreatic cysts is increasing.  Most pancreatic cysts are benign however there are certain radiographic characteristics that increase the chances of it been malignant. These include a size more than 3 cm, thickened wall and presence of enhancing nodules.

As the size of this lesion is 5.3 cm, further investigation is warranted. Endoscopic ultrasound (EUS) can give both a detailed image and provide an FNA for biochemical, cytological and DNA analysis 1.

This case is confusing as on the MRI the lesion has the appearance of a serous cystic neoplasm, however, age and location suggest mucinous cyst. 

Mucinous origin cyst: This is a premalignant tumor, almost exclusively in females, usually between 40-50 years old and located in the tail or body of the pancreas. If the lesion has a peripheral calcification then this allows you to make a specific diagnosis.

Serous origin cyst: This is a benign tumor. The majority are female between 70-80 years old. The location is usually in the head of the pancreas. Multiple cysts often associated with a central scar and calcification. No communication to the main duct is seen on ERCP.

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Case information

rID: 63667
Published: 6th Dec 2018
Last edited: 16th Apr 2019
Inclusion in quiz mode: Included

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