Unusual case of a giant serous oligocystic adenoma with communication to main pancreatic duct

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.).