Non-Endocrine Neoplasm

Benign Tumors

Serous Cystadenoma

Benign tumors without malignant potential

Very rare (<1%)
Mass effect or rapid growth
0.45 cm/year average rate of growth
Asymptomatic and incidental finding 50%
Symptomatic:
mild upper abdominal pain, epigastric fullness, or moderate weight
loss
can grow to a size capable of producing jaundice or GI obstruction
due to mass effect surgical resection

Frequently in older women in which pancreatic resection for a

benign neoplasm should be avoided in the absence of
significant symptoms.
All regions of the pancreas are affected.

Serous Cystadenoma
Spongy appearance, microcystic> macrocystic
Thin serous fluid that does not stain positive for
mucin and is low in CEA (<200 ng/mL)
Typical imaging characteristics:
well-circumscribed cystic mass
small septations
fluid close to water density
central scar with calcification

EUS-FNA
Nonviscous fluid with low CEA and amylase levels,
Cells are obtained: cuboidal and have a clear cytoplasm.

Mucinous Cystadenoma
Benign but potentially malignant
carcinoma with a very aggressive behavior
6% to 36% - reported to be malignant
Commonly seen in perimenopausal
women
2/3 are located in the body or tail of the
pancreas.
Incidental finding
Nonspecific symptoms: upper abdominal
discomfort or pain, early satiety, and weight
loss

Mucinous Cystadenoma
Imaging studies
The cysts have thick walls and do not
communicate with the main pancreatic duct
Nodules or calcifications within the wall of the
cyst
Cysts are lined by tall columnar epithelium
that fills the cyst with viscous mucin
Submucosal layer consists of a highly cellular
stroma of spindle cells with elongated nuclei
Elevated CEA levels in the fluid (>200 ng/mL)
may suggest malignant transformation.

Mucinous Cystadenoma
Resection is the treatment of choice: distal pancreatectomy
Malignant transformation more common with
larger tumors
older patients
stepwise accumulation of mutations (K-ras, p53)
Small lesions
preserve the spleen
splenectomy ensures removal of the lymph node basin
Important not to rupture the cyst during resection and the tumor
should be removed intact, not morselized.
Prognosis
Complete resection, without atypia, small (<3cm) cured
Complete resection with moderate dysplasia or CIST- cured
Invasive carcinoma, mucinous cystadenocarcinoma - dismal

Insert Emis Slide

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