Pancreatic solid serous cystadenoma: a rare entity that can lead to a futile surgery

Although many types of pancreatic tumors exist, pancreatic solid serous cystadenoma stand as the most rare. Despite advances in medical imaging, definitive diagnosis remains complex. Here, we report a case of a 63-year-old man with a suspicious lesion of the pancreas discovered during a positron emission tomography–computed tomography. Despite an echo-endoscopy being performed, no biopsies were contributive. The magnetic resonance imaging did highlight another lesion in the liver. Due to the suspicion of a neuroendocrine tumor of the pancreas with liver metastases, a cephalic duodenopancreatectomy with partial hepatectomy was performed. During the procedure, another hepatic lesion was resected. The final histological diagnosis was a serous solid adenoma of the pancreas associated with a cholangiocarcinoma. During the follow-up, the patient presented a massive metastatic hepatic relapse even after the administration of a palliative chemotherapy.

Computed tomography and magnetic resonance imaging features of solid serous cystadenomas of the pancreas

Solid serous cystadenomas (SSC) of the pancreas are the rarest benign type of serous cystic neoplasms and are frequently misdiagnosed, resulting in unnecessary invasive surgical procedures. A retrospective study was performed to collect imaging features of SSC using computed tomography (CT) and magnetic resonance imaging. The clinical data and imaging study of 5 female patients with pathologically confirmed SSC (mean age, 44.2 years; range, 23-69 years) diagnosed between January 2006 and July 2017 were retrospectively analyzed. The imaging study was assessed by two experienced radiologists in consensus. All patients had tumors with a mean size of 2.3 cm (range, 1.5-3.2 cm; 4/5 lesions ≤3 cm). The tumors were located in the tail of pancreas in 3 cases and in the neck of the pancreas in 2 cases. The tumors were all well defined, with an ovoid and lobulated shape and fibrous capsules. Consequently, they presented as low density on unenhanced CT images, marked hyperintensity on T2-weighted images in 4 cases and slight hyperintensity in 1 case. However, they exhibited heterogeneous wash-in and wash-out enhancement in 2 cases and moderate and prolonged enhancement in 3 cases. The apparent diffusion coefficient (ADC) values of the lesions were >2×10^-3 mm²/sec. Therefore, a small tumor size, signal intensity on T2-weighted images, high ADC values, fibrous capsules and enhancement patterns may be indicative imaging features of SSCs.

Middle segment pancreatectomy for a solid serous cystadenoma diagnosed by MRCP and review of the literature: A case report

Solid serous cystadenoma of the pancreas is the rarest subtype of serous cystadenoma. Cystic structures are difficult to recognize by imaging studies. In the clinical setting, it is crucial to discriminate a solid serious cystadenoma from other solid pancreatic tumors. The present study reported a case of solid serous cystadenoma in which the magnetic resonance cholangiopancreatography (MRCP) findings were useful for diagnosis and decision-making regarding the surgical strategy, with a review of the previous reports of solid serous cystadenoma. A 50-year-old woman was referred to our hospital for investigation of a pancreatic body mass. A 2-cm hypervascular solid tumor was revealed by computed tomography. No typical radiological imaging findings of small cysts were detected, such as a honeycomb structure, and an adequate specimen could not be gained by biopsy under endoscopic ultrasonography. However, the tumor showed high intensity on MRCP, suggesting its cystic nature. A solid serous cystadenoma was suspected based on these radiological findings, and middle segment pancreatectomy was performed as a function-preserving surgery. The histological findings were compatible with a solid serous cystadenoma. In conclusion, MRCP imaging may be helpful for diagnosis and decision-making regarding the most appropriate surgical method for solid serous cystadenomas.

Solid variant of serous cystadenoma of the pancreas

We describe a case of a solid variant of serous cystadenoma of the pancreas. The preoperative examination results led to a diagnosis of a nonfunctional pancreatic islet cell tumour, and the patient underwent a pylorus-preserving pancreaticoduodenectomy. The tumour was diagnosed as a solid variant of serous cystadenoma by histopathological examination. Solid variant of serous cystadenoma of the pancreas is difficult to diagnose preoperatively. More cases must be accumulated and investigated to obtain clues for accurate diagnosis.