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Serous cystadenoma in communication with the pancreatic duct: an unusual radiologic and pathologic entity
Loren Berman1, Kisha A Mitchell, Gary Israel
1Department of Surgery, Yale University School of Medicine, New Haven, CT 06520-8062, USA.
Insights
Serous cystadenomas can rarely communicate with the pancreatic duct, mimicking intraductal papillary mucinous neoplasms (IPMNs). Endoscopic ultrasound (EUS) is crucial for differentiating these pancreatic cysts to guide treatment.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Radiology
Background:
- Cross-sectional imaging is vital for diagnosing pancreatic cysts, but overlapping appearances can complicate diagnosis.
- Differentiating between pancreatic cystic lesions is crucial for appropriate patient management.
Observation:
- A case is presented of a serous cystadenoma found to be communicating with the pancreatic duct, initially presumed to be an intraductal papillary mucinous neoplasm (IPMN).
- A literature review identified three prior reports of serous cystadenomas communicating with the pancreatic duct.
Findings:
- Communication with the pancreatic duct is typically pathognomonic for IPMN.
- Rarely, serous cystadenomas may present with ductal communication, leading to potential misdiagnosis.
- Endoscopic ultrasound (EUS) plays a critical role in preoperative differentiation of pancreatic cystic lesions.
Implications:
- Accurate preoperative diagnosis of pancreatic cysts, particularly distinguishing serous cystadenoma from IPMN, is essential for guiding management.
- EUS is necessary for definitive evaluation when ductal communication is observed.
- If EUS is not feasible, surgical resection is recommended to avoid undertreatment of potentially premalignant IPMN.
Abstract:
Cross-sectional imaging is frequently used in the diagnosis of pancreatic cysts, but there can be overlap in radiographic appearance. We present a case of a patient with presumed intraductal papillary mucinous neoplasm (IPMN) who was ultimately found to have a serous cystadenoma in communication with the pancreatic duct. A literature search for serous cystadenoma communicating with the pancreatic duct was performed and the data was reviewed in the context of this case report. Three reports of patients with serous cystadenoma communicating with the pancreatic duct were identified. Review of current data revealed that endoscopic ultrasound (EUS) has an important role in distinguishing between pancreatic cystic lesions preoperatively. Distinguishing between serous and mucinous cystadenomas and IPMN is essential to guide appropriate management. Although communication with the pancreatic duct is usually pathognomonic of IPMN, rarely this may be a misdiagnosis of a serous cystadenoma and EUS may be necessary for further evaluation. If EUS cannot be performed, resection is favored to avoid undertreating a premalignant lesion.
