Pancreatic serous cystadenoma is a common type of pancreatic cystic tumor and accounts for 10–15% of all cases of pancreatic cystic tumor and 1-2% of primary pancreatic tumors [
We searched clinical data of Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, between January 2003 and December 2015, and a total of 57 cases of pancreatic cystic tumors that were pathologically confirmed were found, including 28 cases of serous cystadenoma, of which 6 (10.5%) were giant pancreatic serous cystadenoma (diameter ≥ 10 cm). This retrospective study, which did not require consent from the patients, was approved by the ethics committee of the hospital.
Before operation, all 6 patients received abdominal 64-slice spiral CT examination (Sensation 64, Siemens Medical Solutions, Erlangen, Germany), including plain scans and triphasic enhanced scans. A nonionic contrast agent (Iopromide, 370 mgI/mL, Schering, Erlangen, Germany) was administered via the antecubital vein using a pressure injector at 3.5 mL/s with a dose of 1.5 mL/kg. Using the bolus tracer function, arterial phase images were collected 10 sec after the intensification threshold of the celiac level aorta reached 100 HU. Portal phase images and delayed phase images were collected 15 and 90 sec after the completion of arterial phase scanning, respectively. The slice thickness of CT image was 3.0 mm. CT angiography (CTA) was accomplished at the CT postprocessing workstation.
The electronic clinical data of these patients were retrospectively analyzed, including gender, age, symptoms, relevant laboratory examination results (e.g., AFP, CEA, CA125, CA199, TDIL, and DBIL), surgical approach, and prognosis.
Two abdominal radiologists retrospectively evaluated the CT images using the picture archiving and communications system. The radiologists were both aware that the 6 patients were diagnosed with pancreatic tumor but did not know other information, including pathological data. Image reviews were done jointly and by consensus. The following CT findings were determined: tumor location, size, shape, capsule, calcification, morphological pattern, enhancement pattern, pancreatic or bile duct dilatation, and other relevant observations. Based on their morphological patterns, the tumors were classified as microcystic, macrocystic (or oligocystic), mixed microcystic and macrocystic, and solid type [
The clinical characteristics of the 6 patients with giant pancreatic serous cystadenoma are summarized in Table
Clinical and CT manifestations of giant pancreatic serous cystadenoma.
Authors | Gender/age (y) | Symptoms | Size (cm) | Location | Morphological patterns | Calcification | CTA or DSA | Relationship with neighboring organs | Surgical procedure | Follow-up and outcome |
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Sakata et al. [ |
F/71 | No | 13.9 | Head | Oligocystic type | No | Stretching of the adjacent vessels | NA | Dome resection with chemocautery using 100 mg minocycline hydrochloride | No postoperative complications and survived after 12 months of follow-up |
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Schulz et al. [ |
F/70 | Abdominal discomfort with vomiting and lost weight | 17.0 | Head | Microcystic type | Yes | NA | Compression of the vena cava, the aorta, left liver lobe, and transverse colon. Involvement of the SMV and PV leading to severe portal hypertension | Right-sided hemicolectomy without tumor resection | Alive after 13 years of follow-up, symptoms are worsening and tumor is growing larger |
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Salemis and Tsohataridis [ |
F/83 | General fatigue, epigastric pain, and weight loss | 23.0 | Head | Macrocystic type | No | NA | NA | Roux-en-Y cystojejunostomy | Alive after 13 years of follow-up, asymptomatic |
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Vernadakis et al. [ |
F/66 | No | 26.0 | Head | Microcystic type | No | NA | Surrounding the right colonic vessels and compressing the IVC | Pylorus-preserving pancreaticoduodenectomy with a right hemicolectomy | Alive without postoperative complications |
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Tajima et al. [ |
F/72 | No | 13.0 | Head | Microcystic type | No | Feeding arteries including GDA, RGA, SA, DPA, and IPDA Enlarged draining veins on the surface (drainage into the PV and SMV) | Tightly adherent to the SMV and PV | Preoperative embolization of the tumor-feeding arteries, pancreaticoduodenectomy; the SMV-PV was resected and reconstructed | Alive without postoperative complications |
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Charalampoudis et al. [ |
M/74 | No | 12.7 | Body-tail | Microcystic type | No | NA | Attached to the splenic porta and the transverse mesocolon | Distal pancreatectomy with splenectomy | Alive without postoperative complications |
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Dikmen et al. [ |
F/64 | Abdominal pain | 15.5 | Head | Microcystic type | No | NA | Compression of the right and left PV, inferior vena cava, left PV, and SMA | Whipple procedure | Alive without postoperative complications |
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Kawaguchi et al. [ |
F/58 | Abdominal bloating | 20.0 | Body | Macrocystic type | No | NA | Compression of the middle part of the gastric body and main pancreatic duct in the tail of the pancreas | Distal pancreatectomy with splenectomy | NA |
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Dokmak et al. [ |
F/33–66 | Pain and fullness in the right subcostal area ( |
12.0, 13.0, and 14.0 | Head ( |
Macrocystic type ( |
NA ( |
NA ( |
NA ( |
Laparoscopic fenestration ( |
Bile duct injury in one patient, pancreatic fistula in another patient At the last follow-up (13, 21, and 26 months), all 3 patients were symptom-free |
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Liu et al. | F/65 | Abdominal bloating and vomiting | 15.3 | Body-tail | Microcystic type | Yes | Lack of abundant feeding arteries (SA and DPA) and draining veins (drainage into the SV) | Encasement or compression of the left RV, the SA and, SV and adherence to the posterior gastric wall | Distal pancreatectomy with splenectomy | No postoperative complications and survived after 14 months of follow-up |
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Liu et al. | M/67 | Acid reflux with abdominal bloating and pain | 14.8 | Body-tail | Microcystic type | Yes | Abundant feeding arteries (SA) and draining veins (drainage into the SV and the SMV) | Encasement of the SA and SV; gastric vein varices, transverse mesocolon adhesions | Distal pancreatectomy with splenectomy and omentum resection | Postoperative infection and fluid accumulation in the surgical area; survived after 49 months of follow-up |
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Liu et al. | M/48 | Abdominal pain and bloating | 10.2 | Body-tail | Microcystic type | No | Abundant feeding artery (SA) and draining veins (drainage into the SMV and the SV) | Compression of the left RV and the SV | Distal pancreatectomy with preserving spleen | Mild postoperative pancreatic fistula, survived after 45 months of follow-up |
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Liu et al. |
F/68 | Abdominal bloating, palpable mass | 16.5 | Head | Mix-type | Yes | Lack of abundant feeding artery (GDA) and draining veins (drainage into the SMV) | Encasement and compression of the GDA, the PV, the SMV, and the CBD | Pancreaticoduodenectomy, repair of the injured portal vein | No postoperative complications and survived after 24 months of follow-up |
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Liu et al. | F/63 | Abdominal pain | 11.2 | Body-tail | Microcystic type | Yes | Abundant feeding artery (SA) and draining veins (drainage into the SMV and the SV) | Encasement and compression of the SA and SV and adherence to the posterior gastric wall and the transverse colon | Distal pancreatectomy withsplenectomy and partial resection of the transverse colon | No postoperative complications and survived after 17 months of follow-up |
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Liu et al. | M/54 | Abdominal bloating | 10.5 | Body-tail | Microcystic type | Yes | Lack of abundant feeding artery (SA) and draining veins (drainage into the SMV and the SV) | Encasement and compression of the SA and SV and gastric vein varices | Distal pancreatectomy with splenectomy | No postoperative complications and survived after 8 months of follow-up |
Note: Y, years; F, female; M, male; PV, portal vein; SMV, superior mesenteric vein; NA, not available; GDA, gastroduodenal artery; RGA, right gastric artery, SA, splenic artery; DPA, dorsal pancreatic artery; IPDA, inferior pancreaticoduodenal arteries; SMA, superior mesenteric artery; IVC, inferior vena cava; SV, splenic vein; RV, renal vein; CBD, common bile duct.
The pancreatic tumors were 10.2–16.5 cm in size (median, 13.0 cm). In 5 patients, the tumors were located at the body-tail of the pancreas; the patients therefore received distal pancreatectomy (4 patients also underwent splenectomy). Among these 5 patients, 2 patients (case
The tumors of the 6 patients generally had clear boundaries without capsule. The gross specimens manifested as honeycomb-like shapes (
A 48-year-old male patient with a giant serous cystadenoma of the pancreas. (a) A low-density pancreatic tumor was noted on CT plain scan. (b) The tumor showed early enhancement with abundant draining vein (arrow) on arterial phase image. (c) The tumor showed honeycomb-like shapes with decreased enhancement on portal phase image. Left renal vein compression was noted (arrow). (d) The feeding splenic artery (short arrow) and draining veins (long arrow) were showed on CT angiography (CTA). (e) The tumor specimen was honeycomb-like appearance with central scars.
A 67-year-old male patient with a giant serous cystadenoma of the pancreas. (a) A low-density, lobulated tumor with dotted calcification and isodense central scar was noted on CT plain scanning. (b) The tumor showed early enhancement on arterial phase image. (c) The honeycomb-like tumor displayed decreased enhancement on portal phase image with a hypodense central scar. (d) CTA showed the feeding splenic artery and draining veins (arrow) on the tumor surface. (e) Portal phase vascular reconstruction showed left gastric vein varices (short arrow) and splenic vein stenosis (long arrow). (f) Tumor specimens displayed a honeycomb-like appearance with abundant central scar.
The tumors of all 6 patients displayed lobulated appearance without capsule. Central calcification was showed in 5 patients. The morphological pattern of the tumor was microcysts (
A 68-year-old female patient with a giant serous cystadenoma of the pancreatic head, concurrent colorectal cancer, and gastric stromal tumor. (a) Intrahepatic bile duct dilation and a gastric stromal tumor (arrow) were detected on CT plain scanning. (b) The pancreatic head tumor showed honeycomb-like appearance with multiple macrocysts and punctuate calcification. ((c) and (d)) Encasement of the portal and superior mesenteric veins (arrow) was noted on portal phase image. (e) The coronal CT image showed a pancreatic head tumor (short arrow) and rectal mass (long arrow).
As imaging technologies improve and are more widely applied, the discovery of asymptomatic cystic tumors of the pancreas has increased. Pancreatic serous cystadenoma is a common type of benign pancreatic cystic tumor and is different from other types of pancreatic cystic tumors (e.g., mucinous cystadenoma and intraductal papillary mucinous neoplasms) that have overt or potential malignancy [
Pancreatic serous cystadenomas are typically small, with a mean diameter of 31 mm [
Morphologically, pancreatic serous cystadenoma can be classified as microcystic, macrocystic (or oligocystic), mixed microcystic and macrocystic, and solid type [
Although pancreatic serous cystadenoma is generally considered a slow-growing benign tumor, symptomatic or giant serous cystadenoma has been proposed to exhibit a high risk of malignant potential [
Treatment for pancreatic serous cystadenoma remains controversial. It is suggested that surgery should be recommended for uncertain cystic tumor (i.e., cases without definitive diagnosis of serous cystadenoma), symptomatic serous cystadenoma (diameter ≥ 4.0 cm), or tumors with rapid growth (annual growth of greater than 4 mm). However, small or asymptomatic pancreatic serous cystadenoma should be provided with conservative treatment and close follow-up [
Due to their large size, giant pancreatic serous cystadenomas usually are symptomatic. Although this type of tumor displays characteristic findings on CT scanning, it is necessary to differentiate this tumor from other pancreatic cystic tumor types. In general, giant pancreatic serous cystadenomas require surgical excision, and the relationship between the tumor and the neighboring organs, blood vessels, and bile duct is critical for determining tumor resectability.
The study was reviewed and approved by the Science and Research Office of Sun Yat-sen Memorial Hospital (Guangzhou).
This retrospective study did not require consent from the patients and was approved by the ethics committee of the hospital.
There are no competing interests to report.
Qing-Yu Liu designed the study and wrote the paper; Xiao-Feng Lin and Yu-Rong Zeng contributed to the analysis and interpretation of imaging data; Jun Zhou and Jun Min participated in the acquisition, analysis, and interpretation of clinical data.