Imaging of pancreatic serous cystadenocarcinoma

Serous cystadenocarcinoma of the pancreas is a rare but well-established entity. The origin of this disorder is speculative, and its evolution remains unclear. On imaging, the malignant behavior of the tumor is best supported by local invasion and/or distant metastasis. The histological characteristics of serous cystadenocarcinoma are indistinguishable from those of its benign counterpart, making the presence of invasion the sole criterion distinguishing the two. The prognosis is excellent even in the face of metastatic disease. We report a case of serous cystadenocarcinoma complicated by recurrent acute and chronic pancreatitis. Initially, no sign of malignancy was seen on imaging. Follow-up study revealed its malignant nature in the form of increased size, presence of duodenal invasion, and multiple liver metastases. The patient underwent Whipple resection with a jejunal Roux-en-Y conduit and microwave coagulonecrotic therapy for metastatic liver lesions. Histopathological examination of the resected specimen revealed a locally invasive cystadenocarcinoma with metastatic disease. One year afterward, the patient is alive with no evidence of progression.