Abstract
BackgroundCystic neoplasms of the pancreas are less common than solid tumors, and portend a better prognosis. They can be divided into serous and mucinous subtypes, with the former behaving less aggressively and generally considered benign. Of the serous neoplasms, serous microcystic adenoma is the most common. An extremely rare solid variant of serous microcystic adenoma lacking secretory capability has been described. Herein, we present the fourth described case of this solid variant and review the literature.Case presentationWe present a case of a 62 year-old man with a history of abdominal pain, who on CT scan was found to have a solid mass at the junction of the head and body of the pancreas. The patient was offered resection for diagnosis and treatment, and subsequently underwent distal pancreatectomy and splenectomy. Based on gross pathology, histology and immunohistochemistry, the mass was determined to be a solid serous microcystic adenoma.ConclusionSolid serous microcystic adenoma shows similar histologic and immunohistologic features to its classic cystic counterpart, but lacks any secretory functionality. It appears to behave in a benign manner, and as such, surgical resection is curative for patients with this tumor. Furthermore, until more cases of solid SMA are identified to further elucidate its natural history and improve the reliability of preoperative diagnosis, surgical resection of this solid pancreatic tumor should be considered standard therapy in order to exclude malignancy.
Highlights
Cystic neoplasms of the pancreas are less common than solid tumors, and portend a better prognosis
Solid serous microcystic adenoma shows similar histologic and immunohistologic features to its classic cystic counterpart, but lacks any secretory functionality. It appears to behave in a benign manner, and as such, surgical resection is curative for patients with this tumor
The serous cystic tumors are comprised of cuboidal cells arising from the pancreatic ductal epithelium, and having clear, glycogen-rich cytoplasm with small, central nuclei [1]
Summary
Solid tumors of the pancreas are typically associated with malignancy, whereas cystic tumors more often tend to be benign [11]. Given the histologic and immunohistochemical characteristics of solid serous microcystic adenoma, it is likely more related to the cystic tumors than to the solid ones, as its gross pathology might suggest. This holds true as well, as the three previous cases have all been considered benign lesions without evidence of local spread or metastasis. Until more cases of solid SMA are identified to further elucidate its natural history and improve the reliability of preoperative diagnosis, surgical resection should still be considered standard therapy in suitable patients to exclude malignancy
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