[Cystadenoma of the pancreas. Three case reports and a review.]

Cystic neoplasms of the pancreas are pathologically divided into macrocystic and microcystic adenomas. Macrocystic adenomas are multilocular, composed of large cysts (>2 cm), with or without septa, lined with columnar mucin-producing epithelium. This type has malignant potential. The microcystic adenomas are composed of many tiny cysts (<2 cm) lined by small cuboidal cells containing glycogen but little or no mucin. This adenoma is completely benign and is therefore important to differentiate from the former. Cystadenomas represent 10-15% of cystic lesions of the pancreas. Roughly one-half of the cystadenomas of the pancreas are found to be microcystic. The remainder is accounted for by the mucinous cystic neoplasms, either macrocystic adenomas or cystadenocarcinomas. These adenomas occur most frequently in middle aged women. Upper abdominal pain and weight loss are often the presenting symptoms. An abdominal mass can often be palpated during physical examination of these patients. Ultrasound and CT of the abdomen are the most useful diagnostic tools in the evaluation of cystic lesions of the pancreas. CT can also be helpful in differentiating microcystic from macrocystic adenomas. It is possible to do a CT or ultrasound guided percutaneous aspiration for diagnosis of the lesions. This technique permits preoperative cytologic and biochemical analysis of the cyst content. Surgery however is often necessary for accurate diagnosis where the tumor is biopsied for histology. The primary pancreatic lesions to be considered in the differential diagnosis include pseudocyst, whether of inflammatory or traumatic origin, congenital cysts, ductal adenocarcinoma or islet cell tumors. Some agree that surgical resection may not be mandatory if an accurate diagnosis of microcystic adenoma can be made. Others emphasize that all pancreatic cystadenomas can have malignant potential and that total excision should be the treatment of choice. Both macrocystic adenomas and cystadenocarcino notmas have a slow and indolent course and tend to be well resectable in spite of late diagnosis. Three cases of pancreatic cystadenomas have been diagnosed in Iceland since 1972. These cases are presented here with a review of the literature.