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
Gender: Female
MRI

MRI Pancreas

  1. Large multicystic lesions within pancreatic tail.  Overall measures 53mm.  Appearance of serous cystic neoplasm however age and location suggestive of mucinous neoplasm.
  2. Uncomplicated gallstones
CT

Abdominal CT

  1. Complex multilocular cystic lesion in pancreatic tail.  Areas of dystrophic calcification related to the traversing septations. ? Primary pancreatic cystic neoplasm.
  2. Umbilical hernia with inflammatory stranding - fat containing
  3. Multiple small nodules attached to gallbladder wall --> ?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 3cm, thickened wall and presence of enhancing nodules.

As the size of this lesion is 5.3cm, further investigation is warranted. Endoscopic ultrasound (EUS) can give both a detailed image and provide a FNA for biochemical, cytological and DNA analysis (1, 2)

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.  Usually in the tail or body of pancreas.  If lesion has a peripheral calcification then this allows you to make a specific diagnosis.

Serous Origin Cyst: This is a benign tumor.  Majority female between 70-80 years old.  Location is usually in the head of the pancreas.  Multiple cysts often associated with a central scar and calcification.  No communication to main duct is seen on a ERCP.

A good table for the diagnosis and management of pancreatic cysts can be found here: https://www.nature.com/articles/ajg201814/figures/1

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Case information

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

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