PMC6581980_01
Endoscopic ultrasound. An anechoic, multicystic, septated and shadowing lesion suggestive of a cyst was identified in the pancreatic body and in the pancreatic tail. No communication with the pancreatic duct. Many thinly septated compartments, with no associated mass or internal debris within the fluid-filled cavity.
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An endoscopic ultrasound (EUS) described a honeycombed appearance with multiple small cysts suggestive of a SCA (Fig. 1).
Computed tomography (CT) Imaging of Giant Serous Cystadenoma. Axial image, venous phase. Complex polycystic mass involving the entirety of the pancreatic body and tail measuring 12.4 x 11.0 cm in axial plane. Close proximity to surrounding visceral and vascular structures with concern for locally aggressive infiltration of this tumor. Coronal image, venous phase. Measuring 13.0 cm in craniocaudal dimension.
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CT at that time reported an increase in the size of the lesion to 12.4 x 11 x 13 cm involving the entire pancreatic body and tail with narrowing of the splenic vein and varices of the short gastric vessels (Fig. 2).
Serous cystadenoma. (A) Well-defined, polycystic mass involving the head of the pancreas. This gross appearance is seen as sponge-like or "honeycomb" on imaging. Note the central stellate scar and the delicate septa which can also be identified on imaging. (B) Low magnification shows a well circumscribed mass, adjacent to uninvolved pancreas (top left), with multiple, back to back, small thin-walled cysts filled with clear serous fluid. Interestingly, the cysts do not communicate with the pancreatic duct as seen in mucinous cystic neoplasms. (C) Rich capillary network contributes to the enhancement on CT imaging. (D) The epithelium lining the cystic spaces is composed of uniform columnar cells with pale cytoplasm rich in glycogen, without atypia or mitotic activity. This bland cytomorphology of a benign neoplasm can be deceiving in cases of serous cystadenocarcinoma, an extremely rare but morphologically indistinguishable tumor from serous cystadenoma.
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Histologic findings confirmed a microcystic SCA (Fig. 3).