Serous microcystic adenoma of pancreas

Abstract

Serous microcystic adenoma (SMCA) is an uncommonpancreatic neoplasm with an incidence of 1% to 2% of allexocrine pancreatic tumors [1, 2]. It has a strikingpredilection for elderly women and a characteristic gross,microscopic and radiologic appearance. The commonpresenting features are abdominal pain, abdominal mass,nausea, vomiting or weight loss. About one-third ofSMCAs are asymptomatic and discovered incidentally onradiologic examination or autopsy.A 62-year-old woman presented with intermittent pain inabdomen since 1 year and abdominal distension withepigastric burning sensation since 1 month. The abdomenwas soft without any tenderness, guarding or rigidity. CTscan of the abdomen revealed a well-defined loculatedhypodense mass in the pancreatic head, sharply demarcatedfrom the adjacent normal pancreas (Fig. 1). There was noabdominal lymphadenopathy. An endoscopy-guided FNACof the mass revealed clusters of benign duct epithelial cells,malignant cells were absent.A clinical diagnosis of pancreatic cystic neoplasm wasmade. Exploratory laparotomy with resection of thetumor was performed. The postoperative period wasuneventful.Awell-encapsulated tumor measuring 5 cm×5 cm×4 cmwas received with a rim of normal pancreas around it. Theexternal surface was bosselated and multicystic. The cutsurface revealed innumerable tiny cysts with a honey combappearance and a central stellate scar (Fig. 2). There was nohemorrhage or necrosis.Microscopic examination revealed multiple cysticspaces of varying caliber lined by a single layer ofcuboidal epithelium. The cells had a clear cytoplasm withintracytoplasmic glycogen granules (periodic acid schiffpositive, diastase sensitive) and round, centrally-placednuclei with inconspicuous nucleoli without any atypia. Adiagnosis of serous microcystic adenoma of pancreas wasmade.Serous microcystic adenoma is a benign pancreatictumor with a characteristic gross and microscopic appear-ance and an excellent prognosis [2, 3]. It is increasinglybeing diagnosed at an asymptomatic stage due to improve-ment in imaging modalities like ultrasound and CTscan.