A serous oligocystic adenoma of the head of the pancreas successfully treated by dome resection and chemocautery: a new approach to serous oligocystic adenoma

Abstract

Serous oligocystic adenoma (SOA) is an extremely rare benign tumor and ill-demarcated large cyst. We report a case of pancreatic SOA. During abdominal ultrasonography (US) for a routine health examination and computed tomography (CT), a 69-year-old woman was found to have a 9-cm unilocular cyst located in the head of her pancreas. After a 2-year follow up, the cyst was seen to increase in size. The results of US, CT, magnetic resonance imaging, endoscopic retrograde cholangiopancreatography (ERCP), and angiography led to suspicion of a benign or low grade malignancy cystadenoma of the pancreas adjacent to the peripheral organs. Fluid analysis and frozen section pathological studies revealed a serous oligocystic adenoma with no malignancy. Dome resection, chemocautery, and omental filling were performed, and the postoperative course was uneventful. SOAs are difficult to diagnose without surgery. When the cyst exists in the head of the pancreas, adjacent to the biliary tract, portal system, or visceral vessels, it is also difficult to perform complete resection without the threat of morbidity or mortality. We have developed a new approach to SOA diagnosis and treatment that involves minimally invasive procedures.

Giant Serous Cystadenoma of the Pancreas (⩾10 cm): The Clinical Features and CT Findings

“…Patients with the portal vein, superior mesenteric vein encasement, or adherence are subjected to vascular resection and reconstruction [7] or incomplete resection with the blood vessels preservation. Laparoscopic fenestration or dome resection with chemocautery is considered for patients with macrocystic (or oligocystic) type tumors [3, 11]. For patients who are ineligible for major operations (e.g., elderly or high-risk individuals), palliative surgery also achieves sound outcome with low mortality and low morbidity [4] (Table 1).…”

“…Because most of these tumors display benign biological behaviors, asymptomatic patients with small tumors are often recommended for conservative treatment [2]. Giant pancreatic serous cystadenoma (diameter ≥ 10 cm) is very rare, and only sporadic cases have been reported [3–11]. In this study, we examined the clinical features and CT findings of 6 cases of giant pancreatic serous cystadenoma.…”

Three Cases of Serous Oligocystic Adenomas of the Pancreas; Evaluation of Cyst Wall Thickness for Preoperative Differentiation from Mucinous Cystic Neoplasms

“…They called a SCN a "microcystic adenoma"; SCNs are commonly composed of numerous small cysts forming a honeycomb-like structure with a central stellate scar. However, as the first description by Lewandrowski et al [3], "macrocystic" or "oligocystic" variants of SCNs composed of several relatively large cysts have been reported [4][5][6][7][8][9][10][11][12][13]. At present, the World Health Organization (WHO) terms this variant serous oligocystic adenoma (SOA) [14].…”