A rare case of serous cystadenocarcinoma of the pancreas

Abstract

Serous cystadenocarcinoma of the pancreas, a rare disease, developed in a 63‐year‐old Japanese woman. Pathologic examinations of the pancreatic tumor at the subtotal pancreatectomy showed it to be serous cystadenoma with focal atypical lesions. Three years after the operation, however, metastatic liver nodules were found, and the histologic characteristics of these lesions were quite similar to those of the pancreatic neoplasm. Both primary and metastatic tumors were composed of multiple cysts separated by fibrous septa. The epithelium of cysts was cuboidal and had clear cytoplasm, which had positive results for periodic acid‐Schiff (PAS) and negative results for PAS with diastase, Alcian blue, and mucicar‐mine. To the knowledge of the authors, serous cystic neoplasms of the pancreas have been uniformly benign in biologic behavior. Recently, however, serous cystadenocarcinoma of the pancreas has been reported as a new entity. The current case is the second reported case and might support the existence of serous cystadenocarcinoma of the pancreas. Cancer 1992; 69:2449‐2453.

Cystic lesions of the pancreas

“…A handful of malignant serous cystic neoplasms, serous cystadenocarcinomas, have been reported. 129,[153][154][155][156][157][158][159][160][161] Most of these were microscopically identical to serous cystadenomas, and no morphologic findings, other than behavior, have been found to distinguish these malignant variants from their benign counterparts. In fact, in some, the diagnosis of malignancy was established only after metastases to the liver were detected.…”

Das seröse Cystadenom des Pankreas

“…Innerhalb dieser Gruppe kann man zwischen der häufigeren mikrocystischen und der sehr seltenen makrocystischen oder auch oligocystischen Form unterscheiden. Als Raritäten wurden auch Einzelfälle von malignen serösen Cystadenocarcinomen berichtet [10,22].…”

“…· Das Postulat einer sicher benignen Dignität der serö-sen Cystadenome kann nicht aufrecht erhalten werden. Zwischenzeitlich wurde mehrfach, wenn auch nur in Einzelberichten, über eine maligne Entartung berichtet [9,10,17,22]. · Die Symptomlosigkeit zum Zeitpunkt der Diagnose ist auf die im Vergleich zu älteren Literaturangaben frü-here Diagnose zurückzuführen [1,16,21].…”

“…Im Gegensatz zu den anderen Subgruppen, die unter der Krankheitsentität ¹cystischer Neoplasien des Pankreasª klassifiziert werden, gelten sie nämlich als benigne, wobei vereinzelte Ausnahmen beschrieben wurden [10,17,22]. Den anderen Formen, vor allem den mucinösen Cystadenomen, wird hingegen ein erhebliches malignes Potential zugeschrieben [11,16,21].…”

The value of standard serum tumor markers in differentiating mucinous from serous cystic tumors of the pancreas: CEA, Ca 19-9, Ca 125, Ca 15-3

“…Serous cystic tumors (SCTs) tend to be microcystic (generally smaller than 2 cm) and are considered to be benign. Its malignant variant is extremely rare, and as a result most authors recommend observation if the patient is asymptomatic [1,2,3,4]. Mucinous cystic tumors (MCTs) of the pancreas are large, measuring up to 10-20 cm, with a higher prevalence in women.…”