Microcystic Serous Cystadenoma Research Articles

Study on the application value of fluorescent laparoscopy in pancreatic tumor surgery.

Fluorescent laparoscopy is rarely used in pancreatic surgery. The aim of this study was to investigate the value of fluorescent laparoscopy in pancreatic tumor surgery. A total of 19 patients with pancreatic tumors who were treated in the Department of Hepatobiliary Surgery at the First Affiliated Hospital of Wannan Medical College from January 2021 to August 2022 were selected. Fluorescent laparoscopy was used intraoperatively, and the imaging characteristics of different tumors were recorded and analyzed. Among the 19 participants, postoperative pathology confirmed 12 cases of pancreatic cancer (8 cases of moderately differentiated adenocarcinoma, 3 cases of moderately-poorly differentiated adenocarcinoma, and 1 case of acinar cell carcinoma), 4 cases of pancreatic cystic tumors (1 case of microcystic serous cystadenoma, 1 case of serous cystadenoma, 1 case of solid pseudopapillary tumor, and 1 case of solid-cystic pseudopapillary tumor), 1 case of pancreatic neuroendocrine tumor (G1 stage), and 2 cases of inflammatory lesions. There were 8 cases of pancreaticoduodenectomy, 6 cases of distal pancreatectomy, 3 cases of middle pancreatectomy, 1 case of local pancreatectomy, and 1 case of duodenum-preserving pancreatic head resection. One minute after intravenous injection of indocyanine green (ICG), 10 of the 12 patients with pancreatic cancer showed tumor peritumor imaging; 2 cases of pancreatic serous cystic tumors did not show imaging; 2 cases of solid pseudopapillary tumors had tumor body imaging; 1 case of neuroendocrine tumor had tumor body imaging, with complete fluorescence imaging after specimen dissection; there were 2 cases pathologically confirmed as inflammatory lesions, 1 case with tumor body imaging, and 1 case with capsule imaging. By reasonably controlling the administration time and dose of ICG during surgery, some pancreatic tumors can be fluorescently imaged, which is beneficial for intraoperative tumor localization and margin determination.

Endovascular treatment of haemorrhagic pancreatic serous cystadenoma

BackgroundPancreatic microcystic serous cystadenoma are rare benign pancreatic tumors. No treatment is needed in most cases as this lesion is often discovered incidentally. Surgery is not required except in symptomatic cases.Case presentationWe report herein a rare case of pancreatic serous cystadenoma complicated with a hemorrhage in a 95 years old patient treated with arterial embolization since surgery was not possible. The patient recovered without any adverse events or bleed recurrence in the 6 months following the procedure.ConclusionHemorrhage secondary to a pancreatic serous cystadenoma was successfully treated with arterial embolization, which may represent an alternative therapeutic option to surgery.

Microcystic serous cystadenoma mimicking pancreatic neuroendocrine neoplasm: report of a resected case with preoperative diagnostic difficulty and review of the literature

BackgroundMicrocystic pancreatic serous cystadenoma (SCA) can be managed without surgery in selected patients. However, the preoperative diagnosis of microcystic SCA remains challenging, and it is potentially misdiagnosed as other pancreatic cystic neoplasms or solid tumors, especially small microcystic SCA.Case presentationThis was a case of a 27-year-old male patient with microcystic SCA causing difficulty in the differential diagnosis from pancreatic neuroendocrine neoplasm (pNEN). A pancreatic tail mass was incidentally discovered on abdominal ultrasound (US). A contrast-enhanced computed tomography (CT) scan revealed a solid tumor measuring 13 mm with early enhancement in the arterial phase at the pancreatic tail. The tumor showed low intensity on T1-weighted magnetic resonance image, high intensity on T2-weighted image, and a slightly hyperechoic mass on endoscopic US (EUS). EUS-fine needle aspiration (EUS-FNA) did not lead to a definitive diagnosis. The tumor was clinically diagnosed as a pNEN, and a laparoscopic spleen-preserving distal pancreatectomy using the Warshaw technique was performed. The final histopathological diagnosis was microcystic SCA.ConclusionSmall microcystic SCA is difficult to distinguish from a hypervascular pancreatic tumor such as pNEN on imaging studies, and it is necessary to focus on the tumor echogenicity of EUS to differentiate microcystic SCA from pNEN preoperatively.

Cystic Lesions of the Pancreas - Expect the Unexpected: Co-Occurence of a Mixed Duct-Type Pancreaticobiliary IPMN and a Microcystic Serous Cystadenoma - A Case Report

Cystic Lesions of the Pancreas - Expect the Unexpected: Co-Occurence of a Mixed Duct-Type Pancreaticobiliary IPMN and a Microcystic Serous Cystadenoma - A Case Report

Cystadénome séreux microkystique : une tumeur rare du pancréas. À propos de deux observations

Microcystic variant of serous cystadenoma of the pancreas is a rare neoplasm; essentially located in the body or tail of the pancreas and associated with the von Hippel-Lindau. Often, patients are asymptomatic and the neoplasm is incidentally discovered. Usually radiographic manifestations are characteristic. Histopathological examination revealed uniform clear cuboidal cells; they can be confused with other clear cell neoplasms like renal cell carcinomas, well-differentiated neuroendocrine tumors and solid pseudopapillary tumors of the pancreas. Immunohistochemistry can be help to establish the diagnosis and to remove differential diagnosis. Serous cystadenoma is a benign neoplasm whose prognosis is excellent. We herein report two cases of microcystic serous cystadenomas of the pancreas diagnosed in two asymptomatic women and review analysis in the literature to remind the main features of this lesion and the main differential diagnosis.

Microcystic Serous Cystadenoma of Pancreas Presenting With Chronic Diarrhea

AbstractPancreatic cystic neoplasms are increasingly being recognized due to widespread use of advanced imaging techniques. The prevalence of pancreatic cystic lesions is estimated to be between 2.6% - 19.6%. Serous Cystic Neoplasms account for nearly 16% of surgically resected th th pancreatic cystic neoplasms. They commonly occur in females between 5 and 6 decade of life. These tumours are essentially benign and asymptomatic unless they attain a large size. Majority of them occur in the body and tail of pancreas. Malignant transformation is reported in 1%-3% of cases. Surgical excision is the treatment of choice. Thus, it is important to accurately diagnose this lesion to avoid unnecessary intervention in the form of chemotherapy or uncalled for surgical resection. We report a rare case of a 65 year old male who presented with a history of intermittent diarrhea.

Enhancing pancreatic mass with normal serum CA19-9: key MDCT features to characterize pancreatic neuroendocrine tumours from its mimics

To determine key MDCT features for characterizing pancreatic neuroendocrine tumours (PNET) from their mimics, which manifest as enhancing pancreatic mass with normal serum CA19-9 level. This retrospective study had institutional review board approval and informed consent was waived. Preoperative multiphase MDCT of 74 patients with enhancing pancreatic masses and normal serum CA19-9 levels were included. Surgical pathologies were PNET (n=42), microcystic serous cystadenomas (m-SCN, n=12) and solid pseudopapillary epithelial neoplasms (SPEN, n=20). Two radiologists independently evaluated CT images with a checklist of findings. Frequencies of findings with each disease entity were compared. Diagnostic accuracy was assessed using the key MDCT features alone and in combination. Inter-observer agreement was evaluated. The most common findings for PNET were mosaic morphological pattern (33/42, 78.6%) and enhancement peak in pancreatic arterial phase (PAP, 32/42, 76.2%), for m-SCN were honeycomb pattern (9/12, 75.0%) and enhancement peak in PAP (10/12, 83.3%) and for SPEN were melting icecream pattern (16/20, 80.0%) and hypo-enhancement in all phases (18/20, 90.0). Using a combination of morphological patterns and enhancement features, PNET was identified with 88% sensitivity and 81% specificity, m-SCN was identified with 83% sensitivity and 94% specificity, and SPEN was identified with 90% sensitivity and 91% specificity. Inter-observer agreement concerning CT findings was good to excellent (κ=0.68 to 0.81, all p<0.01). Morphological features and enhancement patterns on MDCT are key features for characterizing enhancing pancreatic mass with normal serum CA19-9. PNET could be differentiated from its mimics with high accuracy.

Serous cystadenoma of a pancreas: Experience of diagnostics and treatment

Purpose: To analyse the experience of the treatment of patients with pancreatic serous cystadenomas (SCA). Materials and methods: 65 patients (22–77 years) with pancreatic SCA were revealed and treated during 1999–2015. Women prevailed (86,2%). Preoperative inspection: ultrasonography, MSCT and MRI/MRCP. Results: 40,0% of patients didn't have complaints. Complaints were: pain (28,2%), dyspepsia (41,0%), loss of weight (10,2%). Single neoplasms – 63(96,9%), multiple – 2(3,1%). Sizes: from 12,0х9,0 till 72,0 × 58,0 × 57,0 mm. Localization: proximally – 47(72,3%), distally – 17(26,2%), total – 1(1,5%). Radiology criteria of SCA: accurate equal contours; mono-/polycyclic form; liquid structure with existence single (macrocystic – 49(75,4%) or multiple (microcystic – 16(24,6%) partitions; capsule; partition accumulated contrast substance in arterial and venous phases at MSCT/MRI. MRI diagnosed neoplasms more accurately (especially microcystic) and without X-ray loading. 36(73,5%) patients with microcystic neoplasms were operated on. The sizes and localization of macrocystic neoplasms, absence of complaints allowed to leave under supervision without surgical treatment 13(26,5%) patients. Median of supervision – 5,76 ± 3,4 years. Growth of neoplasms wasn't revealed in 9(69,2%) cases. Surgical treatment was carried out at fixing dynamic growth of neoplasm or emergence of complaints. All patients with microcystic neoplasms were operated on. Laparoscopic or robot-assissted equipment preferred at surgical treatment. Recurrence wasn't obtained in any case. Conclusion: Macrocystic SCA prevailed (75,4%) Neoplasms were mainly localized in proximal part of a pancreas (72,3%). MRI is preferable in diagnostics of SCA. Macrocystic SCA can be dynamically observed in the absence of complaints. Microcystic SCA should be subjected surgical treatment.

Serous cystadenoma of the pancreas with atypical clinical manifestations: A case report.

The present study reported a 4.8 cm space-occupying cystic solid mass of the pancreas, which caused recurrent bilateral lower back discomfort in a 60-year-old female. Combined with the clinical data, an impression of a solid-pseudopapillary neoplasm was generated prior to surgery. Abdominal exploration revealed splenic vessel encasement by the mass similar to the invasion observed in a malignant tumor. Distal pancreatectomy with splenectomy was subsequently performed. Grossly, the tumor was solid and consisted of numerous small cysts. Histopathological examination of the cystic solid mass revealed classic microcystic serous cystadenoma of the pancreas. These findings suggested that microcystic serous cystadenoma can exhibit atypical clinical manifestations. Asymptomatic patients with a small lesion (<4 cm) require imaging surveillance every 2 years; however, tumors >4 cm with atypical presentations require surgical resection.

Pancreatic serous cystadenoma – A case report

Microcystic serous cystadenoma is a benign tumor of pancreas, also termed as Clear cell or Glycogen rich adenoma. It occurs at any site in pancreas and composed of small cystic spaces lined by small cuboidal cells with clear cytoplasm, glycogen. There is an association with von Hippel Lindau syndrome in few cases. Clinical symptoms are variable. Excision is almost curative.We report a case of 70 year old male who presented to the OPD with vague complaints of local discomfort. Ultrasound showed a mass in the pancreas. Pancreatectomy was done and diagnosed as microcystic serous cystadenoma of pancreas on histopathology.

Laparoscopic pancreatic resection without advanced laparoscopic devices.

Laparoscopic pancreatic resection has been slow to develop because of the high degree of technical difficulty and generally expensive laparoscopic devices required. We evaluate our experience with laparoscopic resections for pancreatic pathologies without expensive and advanced laparoscopic devices. A prospective evaluation was carried out of consecutive laparoscopic pancreatic resections performed between July 2003-June 2011. Laparoscopic pancreatic resections were attempted in 13 and performed in 10 patients: 6 laparoscopic spleen-preserving distal pancreatectomy and 4 laparoscopic enucleation. Pathological diagnoses: four insulinomas, two serous cystadenoma, two pancreatic pseudocyst, one microcystic serous cystadenoma, two non-functioning neuroendocrine tumors, one leiomyosarcoma, and one case of solid-pseudopapillary tumor. In the laparoscopic operations the mean operative time was 195min and no blood transfusions were required. The mean postoperative hospital stay was 4.7 days. There were three pancreatic fistulas. No patients required a second operation. There were no deaths. Follow-up was available for all patients. Laparoscopic pancreatic resection is feasible and relatively safe without advanced laparoscopic devices. As with open resections, pancreatic fistula is the dominant morbidity. The best indications for a laparoscopic approach are benign pancreatic tumors that are not inside the neck of the pancreas and do not require pancreaticoenteric reconstruction.

Microcystic Serous Cystadenoma of the Pancreas With Subtotal Cystic Degeneration

Pancreatic serous cystadenomas are benign cystic neoplasms. Extensive degeneration mimicking a pancreatic pseudocyst has been described in several types of pancreatic neoplasms but has not been documented in serous cystadenomas. We report subtotal cystic degeneration of microcystic serous cystadenomas (MSCA) that produces radiographic, gross, and microscopic overlap with pancreatic pseudocyst. Resected MSCA with degenerative change were identified from the pathology archives of Memorial Sloan-Kettering Cancer Center and Johns Hopkins Hospital. The clinical, radiographic, gross, and microscopic findings were reviewed. Eight MSCAs with subtotal cystic degeneration were retrieved from among 397 resected serous cystadenomas (2.0%). There were 2 men and 6 women (mean age, 52 y). Available radiographic studies showed classic features of MSCA in 2 of 4 cases. Four cysts were unilocular, and 4 were multilocular. Gross features of MSCA were noted focally in the multilocular cases but were not evident in the unilocular examples. The predominant histologic features were those of pancreatic pseudocyst, including a fibrotic cyst wall lacking epithelium and instead composed of myofibroblastic proliferation, hemorrhage, and inflammation. Residual foci of MSCA were embedded in fibrosis, comprising 5% to 60% of the tumor volume. Most pancreatic serous cystadenomas display characteristic morphology, including a glycogen-rich epithelial lining and prominent subepithelial capillaries; however, extensive degenerative macrocystic change can obscure these classic features. This phenomenon is to be distinguished from macrocystic serous cystadenoma, in which thin-walled macrocystic spaces are epithelium lined. Thus, serous cystadenoma should be included in the differential diagnosis of pancreatic masses with extensive degenerative cystic change.

Carcinoma Ex Microcystic Adenoma of the Pancreas

Serous cystic neoplasms of the pancreas are generally considered benign lesions. Malignant counterparts have been occasionally described, and the diagnosis of malignancy is based solely on the presence of synchronous or metachronous metastases to the lymph nodes or liver, direct tumor invasion into adjacent organs, or vascular invasion. However, these malignant serous cystic tumors are lined by benign-appearing glycogen-rich cuboidal cells, which have been morphologically indistinguishable from benign microcystic serous cystadenoma in all the cases reported so far. We report a unique case of microcystic serous cystadenoma giving rise to carcinoma with distinctive histologic features including signet ring-like cells and solid nests. We believe that this case represents the first case of a cytologically malignant neoplasm arising from a benign serous cystadenoma (carcinoma ex microcystic serous cystadenoma).

Contrast-enhanced harmonic EUS in diagnosis of pancreatic occupying lesions

Objective To evaluate the accuracy of contrast-enhanced harmonic EUS （CEH-EUS） by using a second-generation contrast medium in differential diagnosis of pancreatic occupying lesions. Methods Patients with suspected pancreatic neoplasms or chronic pancreatitis were enrolled and underwent CEH-EUS by using ultrasonic contrast medium Sonovue. Cytological and/or histological diagnoses were made by EUS-FNA and the final follow-up results. Characteristics of enhancement of the target areas, such as enhancement sequence, time features, pattern grade and venous elution degree were investigated. Results A total of 23 patients were enrolled, in which 13 were diagnosed with FNA as having pancreatic cancer, 7 with chronic pancreatitis, 2 with intraductal papillary mucinous neoplasms and 1 with microcystic serous cystadenoma. The accuracy of CEH-EUS was 95.65% , which was significantly higher than that of conventional EUS （78.2%）. Enhancement of pancreatic cancer by CEH-EUS was later than or simultaneous with the nearby tissues, with heterogeneous low enhancement or fulfillment defect areas, and early subsidence without obvious peak. Enhancement of benign pancreatic diseases was simultaneous with the surrounding tissues, with homogenous fulfillment and simultaneous subsidence. Conclusion CEH-EUS is safe, convenient and accurate in diagnosis of pancreatic occupying lesions and can be used as an additional diagnostic method to EUSFNA. Key words: Pancreatic diseases ; Endoscopic uhrasonography ; Diagnosis ; Contrast enhanced harmonic

Magnetic Resonance Imaging of Cystic and Endocrine Pancreatic Neoplasms

This article describes the appearance of miscellaneous cystic and endocrine neoplasms using magnetic resonance imaging (MRI). Magnetic resonance imaging is a useful diagnostic modality in the assessment of various pancreatic neoplasms. Pancreatic endocrine tumors are moderately low in signal intensity on T1-weighted fat-suppressed images and moderately high in signal intensity on T2-weighted fat-suppressed images and demonstrate homogeneous, ring, or diffuse heterogeneous enhancement on immediate postgadolinium gradient echo images. Cystic pancreatic neoplasms, including intraductal papillary mucinous neoplasm, are well demonstrated and subcategorized according to their characteristic cystic configurations on MRI and MR cholangiopancreatography images. Microcystic serous cystadenomas are demonstrated as a honeycombed appearance on T2-weighted images and have a central stellate scar. Mucinous cystic neoplasms usually appear as multilocular cystic masses, with benign forms of macrocystic tumors possessing uniform thickness septations and malignant forms exhibiting irregular septations and tumor nodules. The presence of tumor stroma, invasion of adjacent tissue, or liver metastases can be assessed by MRI. The connection between the pancreatic duct and the cystic tumor is usually well shown on MR cholangiopancreatography images.

An Immunohistochemical and Ultrastructural Study of Pancreatic Microcystic Serous Cyst Adenoma with Special Reference to Tumor-Associated Microvasculature and Vascular Endothelial Growth Factor in Tumor Cells

Pancreatic microcystic serous cyst adenomas are rare exocrine tumors composed of small cysts lined by glycogen-rich cells. The disease may be sporadic or present as part of von Hippel-Lindau (VHL) syndrome. Four sporadic cases of pancreatic serous cyst adenoma were examined by conventional histological, immunohistochemical, and ultrastructural methods. In the present study, new findings include the immunohistochemical identification of vascular endothelial growth factor (VEGF) and the lack of PDX-1 (putative master transcriptional factor in pancreatic stem cells) in the epithelial tumor cells. Ultrastructurally, many small blood vessels were intimately associated with epithelial tumor cells and adjacent fibroblastic cells. The observations suggest the possibility that VEGF-containing tumor cells act in a paracrine fashion to stimulate neovascularization; that peripheral blood in the vascular lumen might be filtered or processed by the endothelial and epithelial tumor cells; and that filtrates might therefore be stored as serous inclusions. It is hypothesized that pancreatic serous cyst adenomas might be under the abnormal regulation of the VHL gene, just like VHL disease itself and certain types of renal cell carcinoma, showing the distinctive histology of a rich vascularity intimately related to epithelial lining cells of cysts accompanied by stromal fibroblasts/myofibroblasts and collagenous stroma.

Cystic neoplasms of the pancreas.

Cystic neoplasms of the pancreas are an important entity for gastroenterologists and endoscopists because these lesions represent the best example of an early malignancy of the pancreas. In the past, cystic neoplasms of the pancreas were thought to be relatively rare, composing less than 10% of cancers of the pancreas. With the increasing use of cross-sectional imaging, an increasing number of these neoplasms are being seen. Cystic lesions of the pancreas are made up of a broad range of neoplastic cysts and inflammatory pseudocysts. The neoplastic cysts manifest a wide range of malignancy, from overtly malignant to premalignant lesions, and benign cystadenomas. Cystic neoplasms of the pancreas can be divided into two major categories, mucinous and nonmucinous lesions (Table 1) (1). There are three types of mucinous lesions, benign mucinous cystadenomas, malignant mucinous cystic lesions, and intraductal papillary mucinous neoplasms (IPMNs). The nonmucinous lesions include microcystic serous cystadenomas and the cystic endocrine tumors.

Macrocystic serous adenoma of the pancreas: radiologic-pathologic correlation.

Macrocystic serous adenoma is a rare benign pancreatic neoplasm, recently described in the pathology literature. We describe the CT and MR imaging features in a series of five consecutive pathologically proven cases. Of seven cases fulfilling the pathology criteria for macrocystic serous adenoma over an 11-year period, five patients underwent preoperative CT and MR imaging at our institution. In addition to the clinical presentation and pathologic features of the tumor, the following CT and MR imaging features were reviewed: size and location; wall thickness; internal septations; and presence of mural nodules, papillary projections, or calcifications. All patients but one were women (age range, 36-78 years; mean age, 48.6 years). The sizes of the tumors ranged from 1.5 to 5.0 cm (mean, 3.1 cm). Three (60%) of five tumors were located in the pancreatic head. The wall measured less than 2 mm in four lesions and 4 mm in one. No mural nodules, papillary projections, or calcifications were present. Lesions were unilocular (n = 3) or bilocular (n = 2). Excellent correlation of imaging features with gross pathology was observed. On CT and MR imaging, the macrocystic variant of serous adenoma typically appears as a small (< 5 cm), uni- or bilocular cyst with a thin (< 2 mm) wall that lacks mural nodules or calcifications. The imaging appearance of macrocystic serous adenoma is distinctly different from that of microcystic serous cystadenoma, but the imaging appearance of macrocystic serous adenoma is indistinguishable from mucinous cystadenoma and cystadenocarcinoma of the pancreas.

Pancreatic diseases past and present: a historical examination of exhibition specimens from the Collectio Rokitansky in Vienna.

The Viennese collection of pathological specimens (Collectio Rokitansky) comprises a large number of objects from all fields of pathological anatomy and is one of the largest historical collections in the entire world. We reviewed the original diagnoses in a series of pancreatic specimens using modern histopathological techniques. It was found that the histological structure of eleven pancreatic specimens was surprisingly well preserved. In three cases of extrapancreatic pseudocysts, we identified chronic pancreatitis as the underlying disease. Two specimens contained tumours that proved to be ductal adenocarcinomas. A third, rather large tumour was identified as a solid-pseudopapillary carcinoma and a fourth one as a neuroendocrine carcinoma. The remaining cases were classified as fibrotic atrophy, congenital cysts, microcystic serous cystadenoma, and necrotic sequestration of the pancreas. The application of immunohistochemical methods failed. In conclusion, the surprisingly well-preserved exhibits from the Collectio Rokitansky, which have been on display for more than 100 years, are accessible to modern histopathological investigation without the use of immunohistochemical techniques. Such examinations allow us to assess the occurrence of diseases and tumours in the sociocultural environment of the 19th century.

Incidental Detection of a Microcystic Adenoma of the Pancreas

Cystic neoplasms of the pancreas are uncommon. The two major types of cystic pancreatic neoplasms are microcystic (serous) cystadenoma and mucinous cystic lesions (mucinous cystadenoma and mucinous cystadenocarcinoma). The two types differ substantially in the long-term mortality. Symptoms and signs do not distinguish between the two types, and small lesions are often asymptomatic. The neoplasms may be discovered during imaging procedures for unrelated complaints. Computerized tomography may suggest the diagnosis of microcystic adenoma or mucinous cystic neoplasm when the features are typical, but the final diagnosis must be established by surgical biopsy. Characteristic gross findings, light microscopic findings, and immunohistochemical staining patterns distinguish between the two types. When preliminary open biopsy confirms microcystic adenoma, extensive unnecessary surgery can be avoided.