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Special Feature
October 1, 2003

Image of the Month—Diagnosis

Author Affiliations
 

GRACE S.ROZYCKIMD

Arch Surg. 2003;138(10):1158. doi:10.1001/archsurg.138.10.1157
Answer: Giant Serous Microcystic Cystadenoma of the Pancreas

Figure 1. Computed tomographic scan. There is a well-defined mass in the pancreas body.

Figure 2. Near-total distal pancreatectomy and splenectomy specimen.

Cystic tumors of the pancreas are rare, yet surgeons are increasingly being asked to consult on patients who have a pancreatic cyst or mass. In most instances, the lesion is discovered on imaging studies done for other reasons or on abdominal ultrasound or abdominal CT scans requested for unrelated symptoms.1 Occasionally, the cyst is discovered on imaging studies for mild abdominal symptoms caused by the cyst itself. In most cases, surgical exploration and often resection of the cystic neoplasm is necessary for establishing a definitive diagnosis; resection remains the treatment of choice.2

There are several types of pancreatic cystic tumors: serous cystic tumor, serous cystadenoma (microcystic or oligocystic), cystadenocarcinoma, and mucinous cystic tumor. Serous cystadenomas are almost always benign and remain benign. Mucinous cystic tumors may be benign or may become malignant.3 At times, abdominal CT scan or magnetic resonance imaging of the pancreas can help distinguish a serous cystadenoma from a mucinous cystic tumor. Increasingly, we now rely on the characteristics of the fluid obtained with CT guidance to help distinguish a mucinous tumor from a serous cystadenoma. Fluid can be aspirated by a radiologist or endoscopist. Fluid laboratory testing may help in differentiating different cystic forms by determination of carcinoembryonic antigen and pS2 protein and may also help to establish a prognosis.4,5

In addition to these cystic structures, there is a variety of other cystic tumors of the pancreas that take origin from the islet cells, acinar cells, ductal cells, and blood vessels. Cysts are also associated with polycystic renal disease, Von Hippel-Lindau disease, and echinococcal disease in prevalent areas.

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Corresponding author and reprints: Echenique-Elizondo, MD, Basque Country University, Unidad Docente de Medicina de San Sebastián, Paseo Dr Beguiristain, 105, 20014 San Sebastián, Spain (e-mail: gepecelm@sc.ehu.es).

References
1.
Ros  PRMortele  KJ Imaging features of pancreatic neoplasms. JBR-BTR. 2001;84239- 249
2.
Fernandez-del Castillo  CWarshaw  AL Current management of cystic neoplasms of the pancreas. Adv Surg. 2000;34237- 248
3.
Balcom IV  JHFernandez-Del Castillo  CWarshaw  AL Cystic lesions in the pancreas: when to watch, when to resect. Curr Gastroenterol Rep. 2000;2152- 158Article
4.
Yang  JMLee  JSouthern  JFWarshaw  ALDhanak  ELewandrowski  KB Measurement of pS2 protein in pancreatic cyst fluids: evidence for a potential role of pS2 protein in the pathogenesis of mucinous cystic tumors. Int J Pancreatol. 1998;24181- 186
5.
Lewandrowski  KBWarshaw  ALCompton  CCPins  MRSouthern  JF Variability in cyst fluid carcinoembryonic antigen level, fluid viscosity, amylase content, and cytologic findings among multiple loculi of a pancreatic mucinous cystic neoplasm. Am J Clin Pathol. 1993;100425- 427
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