Incidentally detected microcystic serous cystadenoma of the pancreas with splenic invasion: a case report and literature review

Abstract

Serous cystic neoplasms are relatively uncommon and rarely possess malignant potential. We report a rare case of pancreatic serous cystadenoma with splenic invasion in a female in her 60s. Dynamic contrast-enhanced CT revealed a 3 cm mass in the tail of the pancreas. The lesion showed marked enhancement in the arterial phase on dynamic CT, which extended into the spleen. No cystic components were detected in the pancreatic mass on either magnetic resonance cholangiopancreatography or T2 weighted imaging. No metastasis or lymph node swelling was detected. Based on the hypervascularity of the tumour, the pre-operative diagnosis was pancreatic neuroendocrine tumour with splenic invasion. The patient underwent laparoscopic distal pancreatectomy with splenectomy. The pathological diagnosis was microcystic serous cystadenoma with locally aggressive features (infiltration into spleen, lymph nodes, and splenic vein). A few cases of pancreatic serous cystadenomas with splenic invasion have been reported; all were symptomatic, with diameters greater than approximately 9 cm. This is the first known case of incidentally detected serous cystadenoma with splenic invasion, reported with detailed imaging findings of dynamic CT and MRI.

Microcystic serous cystadenoma of the pancreas causing biliary obstruction: a case report and review of the literature

“…Microcystic serous cystic neoplasms are the most common and macroscopically are composed of many small cysts with a ‘honeycomb’ appearance. Pathognomonic calcifications with a fibrous central scar are less commonly detected in ~30% of cases [ 9 ]. Fibrosis can mimic mural nodules seen in IPMNs, which can complicate diagnosis [ 10 ].…”

“…Fibrosis can mimic mural nodules seen in IPMNs, which can complicate diagnosis [ 10 ]. Macrocystic serous cystic neoplasms have fewer cysts with thin walls that are larger in size (> 2 cm) [ 9 ]. The present case, microscopically, was composed of fibrous pancreatic tissue with numerous small cysts consistent with a pathological diagnosis of microcystic serous adenoma based on the WHO classification system.…”