Images in Gastroenterology and Hepatology
Giant Pancreatic Cyst: An Unusual Entity
Quisto Gigante do Pâncreas: Entidade Pouco Comum
Rita Vale Rodriguesa,, , Sandra Faiasa, Ricardo Fonsecab
a Gastroenterology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
b Pathology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
Received 24 December 2015, Accepted 09 February 2016
Keywords
Endosonography, Pancreatic Cyst

A 74-year-old woman was referred for further evaluation of a large pancreatic cystic lesion. She presented with abdominal discomfort, without weight loss, anorexia or history of pancreatitis or abdominal trauma. Physical examination revealed a large epigastric mass. A contrast-enhanced computed tomography (CT) showed a huge, well-defined, multiloculated cyst of 12cm in greatest dimension arising from the pancreatic body, with multiple wall calcifications, without typical imaging features of a particular pancreatic cystic neoplasm (Fig. 1). Endoscopic ultrasound (EUS) showed a multilocular cyst with a larger cyst (120mm×70mm) and a peripheral microcystic component (Fig. 2). EUS-guided fine-needle aspiration of 7mL of serous cystic fluid was performed from the largest cyst under prophylactic IV antibiotics. The sample had no malignant or mucus-producing cells and CEA (<2.5ng/mL) and amylase (41U/L) were within the reference values, making a serous cystadenoma the most likely diagnosis. Due to persistent epigastric discomfort, a distal pancreatectomy and splenectomy was performed (Fig. 3). Macroscopic examination of the resected specimen showed a combination of large cysts with several small cysts. On microscopy, the cysts were lined with a single layer of cuboidal epithelial cells with clear cytoplasm, PAS positive (Fig. 4). Histopathological examination confirmed the diagnosis of a pancreatic serous oligocystic adenoma.

Figure 1.
(0.11MB).

Computed tomography: giant well-defined multiloculated cystic mass in the body of the pancreas.

Figure 2.
(0.13MB).

Endoscopic ultrasound: large multilocular cyst (A) with a microcystic pattern component (B).

Figure 3.
(0.24MB).

Macroscopic appearance of the resected pancreatic cyst.

Figure 4.
(0.19MB).

Microscopic appearance of the pancreatic cyst wall with a single layer of cuboidal epithelial cells with clear cytoplasm (H&E 100×).

Serous oligocystic adenoma (SOA) is a rare benign pancreatic tumor which represent an atypical macroscopic morphologic variant of serous cystadenomas (SCA).1 SOAs are characterized by a limited number of cysts with a diameter of >2cm and share imaging features overlapping those of mucinous cystic neoplasm (MCN) and branch-duct intraductal papillary mucinous neoplasm (BD-IPMN), thus frequently making the radiologic diagnosis difficult.2 Endoscopic ultrasound and cyst fluid aspiration have a role in distinguishing mucinous and serous lesions.3 Management is determined by the presence of symptoms. Giant serous cystadenomas are also rare; this term usually refers to a multicystic tumor larger than 10cm in diameter in comparison with a described mean tumor diameter of 5cm.4

Ethical disclosuresProtection of human and animal subjects

The authors declare that no experiments were performed on humans or animals for this study.

Confidentiality of data

The authors declare that they have followed the protocols of their work center on the publication of patient data.

Right to privacy and informed consent

The authors declare that no patient data appear in this article.

Conflicts of interest

The authors have no conflicts of interest to declare.

References
1
C. Capella,E. Solcia,G. Kloppel,R.H. Hruban
Serous cystic neoplasms of the pancreas
World Health Organization classification of tumours: pathology and genetics of tumours of the digestive system, pp. 231-233
2
J.H. Lee,J.K. Kim,T.H. Kim,M.S. Park,J.S. Yu,J.Y. Choi
MRI features of serous oligocystic adenoma of the pancreas: differentiation from mucinous cystic neoplasm of the pancreas
Br J Radiol, 85 (2012), pp. 571-576 http://dx.doi.org/10.1259/bjr/42007785
3
D. O’Toole,L. Palazzo,P. Hammel,L. Ben Yaghlene,A. Couvelard,M. Felce-Dachez
Macrocystic pancreatic cystadenoma: the role of EUS and cyst fluid analysis in distinguishing mucinous and serous lesions
Gastrointest Endosc, 59 (2004), pp. 823-829
4
C. Galanis,A. Zamani,J.L. Cameron,K.A. Campbell,K.D. Lillemoe,D. Caparrelli
Resected serous cystic neoplasms of the pancreas: a review of 158 patients with recommendations for treatment
J Gastrointest Surg, 11 (2007), pp. 820-826

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