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Macrocystic serous adenoma of the pancreas
Rachel Khadaroo1, Norman Knetman, Steven Joy
1Department of Surgery, University of Alberta Hospital, Edmonton, Canada.
Abstract:
Macrocystic serous adenoma of the pancreas (MSAP) is a rare neoplasm. Its preoperative diagnosis by physical examination and imaging studies is challenging, if not impossible. In recent years, a few cases of MSAP with correct cytodiagnosis by transabdominal fine-needle aspiration (TFNA) have been documented. This paper reports two cases of MSAP that were successfully diagnosed by TFNA cytology. Two adult women presented with epigastric discomfort. Abdominal imaging studies revealed a large pancreatic cystic lesion in both cases. TFNAs of the pancreatic lesions were subsequently performed and revealed a clear serous fluid containing small monolayered sheets of benign cuboidal epithelial cells with scant, clear or granular cytoplasm, vesicular nuclei and micronucleoli. The cell cytoplasm stained positively with periodic acid-Schiff (PAS) and negatively with PAS with prior digestion with diastase (PASD). The cytological findings in both cases were similar and suggested a serous cystadenoma. The two pancreatic lesions were removed by Whipple's operation. They showed features of a macrocystic serous adenoma of the pancreas that were characterized by a small number of large cystic cavities lined by a single layer of non-mucus secreting, PAS-positive and PASD-negative cuboidal epithelial cells. By electron microscopy, the epithelial lining cells showed short and aborted apical microvilli, well-formed desmosomes and a large amount of intracytoplasmic glycogen, suggesting a centroacinar ductal cell origin.
Insights
Diagnosing macrocystic serous adenoma of the pancreas (MSAP) is difficult. Transabdominal fine-needle aspiration (TFNA) cytology successfully identified MSAP in two patients, aiding in preoperative diagnosis.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Pathology
- Cytopathology
Background:
- Macrocystic serous adenoma of the pancreas (MSAP) is a rare pancreatic neoplasm.
- Preoperative diagnosis of MSAP is challenging using physical examination and imaging studies alone.
- Accurate preoperative diagnosis is crucial for appropriate patient management and surgical planning.
Observation:
- Two adult female patients presented with epigastric discomfort and were found to have large pancreatic cystic lesions on abdominal imaging.
- Transabdominal fine-needle aspiration (TFNA) cytology was performed on both pancreatic lesions.
- Cytological analysis revealed clear serous fluid with benign cuboidal epithelial cells, positive for Periodic Acid-Schiff (PAS) and negative for PAS with diastase (PASD).
Findings:
- The cytological findings were consistent with a serous cystadenoma.
- Histopathological examination of the resected lesions confirmed the diagnosis of macrocystic serous adenoma of the pancreas.
- Electron microscopy suggested a centroacinar ductal cell origin based on the presence of glycogen and specific cellular structures.
Implications:
- TFNA cytology is a valuable tool for the preoperative diagnosis of macrocystic serous adenoma of the pancreas.
- Successful cytodiagnosis can guide surgical decisions and potentially avoid unnecessary invasive procedures.
- Further research into the utility of TFNA for rare pancreatic neoplasms is warranted.