Abstract
Benign serous cystic tumors of the pancreas are rare and include microcystic serous adenoma, serous oligocystic adenoma (SOA), ill-demarcated adenoma, and macrocystic serous cystadenoma. Microcystic serous adenoma usually present are either unilocular cyst or single lesion containing fewer cysts of more than 2 cm in diameter. It is a rare tumor which usually varies from 210 cm in size and at times difficult to differentiate from mucinous cyst. With firm diagnosis small asymptomatic SOAs could be managed without surgery. We describe here a case of middle aged male with a giant serous oligocystic adenoma of 15 cm size arising from head of pancreas producing pressure symptoms. Endoscopic ultrasound and cyst fluid tumor markers were suggestive of serous cystadenoma, computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) scan were indicative of mucinous adenoma showing unilocular cyst with dilated common bile duct (CBD), main pancreatic duct (MPD) and communication of cyst with main pancreatic duct. A pancreaticoduodenectomy was done. Histopathology reported the lesion as serous oligocystic adenoma. We are presenting this case due to unusual features, a large unilocular cyst of more than 15 cm in size presented with waxing/waning of surgical obstructive jaundice and on MRCP there was a communication of cyst with MPD with cyst wall thickness of 1 cm (approx.).
Highlights
Cystic neoplasm of pancreas is relatively a common entity and is second only to adenocarcinoma of pancreas
serous oligocystic adenoma (SOA) can be mistaken for mucinous cystic neoplasm, pseudocyst or intraductal papillary mucinous tumor because of relatively large cystic spaces [9]
Giant serous cystadenoma refer to a cystic pancreatic tumor with a diameter of 10 cm or more, which is very rare in comparison to mean tumor diameter of 4–5 cm [10]
Summary
Cystic neoplasm of pancreas is relatively a common entity and is second only to adenocarcinoma of pancreas. A 41-year-old male patient with borderline hypertension, presented to us with complaints of jaundice and postprandial vomiting started one and a half months before without any fever or alteration of bowel, bladder habit. He noticed a spontaneous partial relief of his symptoms for 10–15 days before he presented to us. Physical examination revealed a large firm mass present in upper abdomen extending from right hypochondrium, epigastrium to right lumber and umbilical region It was non-tender, partially fixed, and dull on percussion without any abnormal pulsation. Final histopathological diagnosis was serous oligocystic adenoma head of pancreas
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