Serous cystadenoma of the pancreas (?)

source of the following text: radiopaedia.org

A serous cystadenoma of the pancreas (microcystic adenoma) is an uncommon type of benign cystic pancreatic neoplasm.

Pathology

Typically large lesion at presentation ( ~ 5 cm) and characterised by innumerable glycogen rich flat or cuboidal epithelial lined cysts seperated by fibrous septa. There can be signifcant variation in locule size (1 – 2cm) ^2-4. Three morphological patterns have been described ¹

polycystic : 70 %
honeycomb : 20 %
oligocystic (macrocystic variant) : < 10 % (cysts can be larger than 2 cm)

Demographics and clinical presentation

There is a recognised strong female predilection (M : F ~ 1 : 4 and usually presents in the middle age to elderly ( > 60 years of age).
Many patients are asymptomatic. Some may present with pain, weight loss jaundice or a mass ^4,6.

Associations

von Hippel Lindau (vHL) disease : can be multiple or diffuse and present at a younger age.

Radiographic features

Plain film

can be normal
may demonstrate amorphous central calcification overlying the pancreas

Ultrasound

typically shows an echogenic mass in the pancreatic head region due to the nature of microcysts (the oligocystic sub type may individually identify cysts ⁶)

CT

typically demonstrates a multicystic, lobulated mass in the pancreatic head region.
a characteristic enhancing central scar may be present which can show associated stellate calcification (present in ~ 20 % of cases)

MRI

T1 : typically low signal
T2 : the central fibrous scar (if present) is low signal while cystic components themselves are high signal

Angiography

may show enhancement due to hypervascular components ⁴

Treatment and prognosis

Most lesions are observed ⁶. They are benign lesions and do not recur once resected ⁴.

Differential diagnosis

pancreatic pseudocyst
mucinous cystic neoplasm of pancreas (e.g mucinous cystadenoma)
Intraductal papillary mucinous tumour (IPMN) of pancreas : communicated with pancreatic ducts