Gastrointestinal - Learning Modules - CTisus.com CT Scanning

Learning Modules ❯ Gastrointestinal

CT of Serous Cystadenomas of the Pancreas: A Lesion of Many Different Appearances

Elliot K. Fishman M.D.
Johns Hopkins Hospital

Click here to view this module as a video lecture.

Cystic Pancreatic Tumors

IPMN (Intraductal papillary Mucinous neoplasm)
MCN (Mucinous Cystic Neoplasm)
SCN (Serous Cystadenoma)
cystic neuroendocrine neoplasm (PNET)
solid-pseudopapillary neoplasm (SPEN)
acinar-cell cystic neoplasm
ductal adenocarcinoma with cystic degeneration (PDAC)
Lymphoepithelial cyst

Serous Cystadenoma: Facts

one-third of pancreatic cystic neoplasms
almost always benign
occur more commonly in women
usually present between the 5th and 7th decade of life (mean age 62 years)
More common in patients with VHL

Serous Cystadenoma: Facts

Microcystic (multiple cysts under 2cm with septa and a honeycomb appearance)
Macrocystic (multiple cysts over 2cm)
mixed microcystic and macrocystic (mix of cysts over and under 2cm)
Solid (often enhancing and looking like PNET)

Serous Cystadenoma: CT Findings

Calcifications in up to 30% of cases
Patterns of calcifications are variable
More common in body and tail of pancreas
Classic cases are easy to diagnosis but many cases are atypical

Serous Cystadenoma: Pathology Findings

Serous cystadenoma shows low viscosity, low amylase level, and low CEA levels (<5 to 20 ng/mL), with variable levels of pancreatic enzymes such as Amylase isoenzymes and CA-125. Cancer antigen (CA 72-4) level is low as well.

Serous Cystadenoma: Differential Diagnosis

IPMN (Intraductal papillary Mucinous neoplasm)
MCN (Mucinous Cystic Neoplasm)
SCN (Serous Cystadenoma)
cystic neuroendocrine neoplasm (PNET)
solid-pseudopapillary neoplasm (SPEN)
acinar-cell cystic neoplasm
ductal adenocarcinoma with cystic degeneration
Lymphoepithelial cyst

“Classically, pancreatic serous cystadenomas have been described as multilobulated multiloculated cystic masses with central stellate scars and calcifications. However, serous cystadenomas have a wide spectrum of CT appearance, ranging from unilocular cystic masses to hypervascular solid masses, which can mimic other benign and malignant pancreatic masses. Serous cystadenomas can be morphologically classified as polycystic (or microcystic), honeycomb, oligocystic, and solid patterns.”
The many faces of pancreatic serous cystadenoma: Radiologic and pathologic correlation,
L.C. Chu, A.D. Singhi, R.R. Haroun, R.H. Hruban, E.K. Fishman
Diagnostic and Interventional Imaging,Volume 98, Issue 3,2017, Pages 191-202

The many faces of pancreatic serous cystadenoma: Radiologic and pathologic correlation,
L.C. Chu, A.D. Singhi, R.R. Haroun, R.H. Hruban, E.K. Fishman
Diagnostic and Interventional Imaging,Volume 98, Issue 3,2017, Pages 191-202

Serous Cystadenoma of the Pancreas

”The microcystic pattern, or polycystic pattern, is present in 1–2% of all exocrine pancreatic tumors and in 70% cases of serous cystadenomas, and consists of a collection of cysts (usually more than 6) that range from a few millimeters up to 2 cm in size. Fine external lobulations are a common and characteristic feature. A fibrous central scar with or without a stellate pattern of calcifications, seen in 30% of cases, is highly specific for serous cystadenoma. Serous cystadenomas do not usually communicate with the pancreatic duct.”
The many faces of pancreatic serous cystadenoma: Radiologic and pathologic correlation,
L.C. Chu, A.D. Singhi, R.R. Haroun, R.H. Hruban, E.K. Fishman
Diagnostic and Interventional Imaging,Volume 98, Issue 3,2017, Pages 191-202

Serous Cystadenoma with Multiple Small Cysts

Pancreas Mass Detected for r/o Dissection

Serous Cystadenoma