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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.
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: firstname.lastname@example.org).
Image of the Month—Diagnosis. Arch Surg. 2003;138(10):1158. doi:10.1001/archsurg.138.10.1157
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