Imaging Pearls ❯ Pancreas ❯ Serous Cystadenoma (SCA)
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- Background Solid pancreatic serous cystadenoma (SCA) may present as a hypervascular mass and mimic nonfunctioning pancreatic neuroendocrine tumour (NF-pNET), potentially leading to pancreatic resection for benign disease. We synthesized the available evidence on this diagnostic pitfall.
Conclusions NF-pNET–mimicking SCA is an uncommon but clinically consequential benign mimic. In the available retrospective comparative cohorts of resected, pathology-proven lesions, lower unenhanced CT attenuation (and attenuation ratios) and higher DWI–ADC values consistently favored SCA over NF-pNET, whereas arterial hyperenhancement and positive somatostatin receptor imaging uptake were not specific. These findings may support cautious multiparametric assessment in selected hypervascular solid-appearing pancreatic lesions, but should not be applied as definitive diagnostic thresholds without external validation.
Hypervascular solid-appearing serous cystadenoma as a mimic of nonfunctioning pancreatic neuroendocrine tumour: a systematic review.
Annecchiarico M, Loiaco G, Argenio G, et al.
Abdom Radiol (NY). 2026 Apr 25. Epub ahead of print. - Solid SCA is a recognised radiological pitfall; it may present as a hypervascular solid lesion, thus mimicking potentially malignant pancreatic lesions, particularly nonfunctioning pancreatic neuroendocrine tumour (NF-pNET) . The solid variant is rare, and diagnostic confusion typically arises when individual microcysts fall below the spatial resolution of conventional cross-sectional imaging (computed tomography [CT] or magnetic resonance imaging [MRI]), resulting in a pseudo-solid hypervascular appearance.
Hypervascular solid-appearing serous cystadenoma as a mimic of nonfunctioning pancreatic neuroendocrine tumour: a systematic review.
Annecchiarico M, Loiaco G, Argenio G, et al.
Abdom Radiol (NY). 2026 Apr 25. Epub ahead of print. - This systematic review highlights that SCA may occasionally mimic NF-pNET on preoperative assessment and that enhancement behavior alone is insufficient to resolve the differential diagnosis. When uncertainty persists in a resectable hypervascular solid pancreatic lesion, management may escalate to pancreatic resection for what ultimately proves to be a benign disease. This is particularly relevant because guideline frameworks support conservative management when a serous cystic neoplasm is confidently diagnosed, whereas surgical resection remains an accepted option for selected NF-pNET within guideline-based pathways [3, 8]. In our synthesis, most NF-pNET–mimicking SCA were reported as the solid variant (67/89, 75.3%), although microcystic lesions were also represented (12/89, 13.5%). This reflects the recognized spectrum of serous cystic neoplasms, in which small cystic spaces and enhancing septa may produce an apparently solid hypervascular mass.
Hypervascular solid-appearing serous cystadenoma as a mimic of nonfunctioning pancreatic neuroendocrine tumour: a systematic review.
Annecchiarico M, Loiaco G, Argenio G, et al.
Abdom Radiol (NY). 2026 Apr 25. Epub ahead of print. - NF-pNET–mimicking SCA is an uncommon but clinically consequential benign mimic that may appear solid or pseudo-solid and may also show somatostatin receptor imaging avidity. In the available retrospective comparative cohorts of resected, pathology-proven lesions, lower unenhanced CT attenuation (and attenuation ratios) and higher DWI–ADC values consistently favored SCA over NF-pNET, whereas arterial hyperenhancement and positive 68Ga-DOTA–peptide uptake were not specific. Accordingly, in hypervascular solid-appearing pancreatic lesions with discordant features, these quantitative CT/MRI markers may serve as useful adjuncts within multidisciplinary assessment, while EUS-guided tissue acquisition may be considered when tissue confirmation would alter management. Because current evidence derives from small, selected retrospective series without external validation, these findings should be applied cautiously and not as definitive diagnostic thresholds.
Hypervascular solid-appearing serous cystadenoma as a mimic of nonfunctioning pancreatic neuroendocrine tumour: a systematic review.
Annecchiarico M, Loiaco G, Argenio G, et al.
Abdom Radiol (NY). 2026 Apr 25. Epub ahead of print.
- Serous cystadenoma (SCA) is the most common benign cystic lesion of the pancreas, often an incidental finding on CT scans. Despite their characteristic features such as microcystic or honeycomb appearance, central scar, or lobulated margins, SCAs can display a range of morphologies, complicating their diagnosis and leading to potential confusion with premalignant or malignant lesions. Cinematic rendering (CR), a recent three-dimensional technique, producing striking lifelike images and enhancing visualization of subtle internal structures compared to conventional imaging. In this review, we demonstrate how CR improves the depiction of microcystic, honeycomb, macrocystic, and solid SCA patterns, as well as atypical featuresthat can mislead radiologists. To the best of our knowledge, this is the first review to highlight CR’s ability to define the full spectrum of SCA appearances on CT. Case examples illustrate how CR accentuates tissue textures, clarifies spatial and vascular relationships, and highlights details such as septations and calcification. By refining assessment of internal and external lesion characteristics, CR has the potential to augment standard CT and facilitate accurate differentiation from other pancreatic lesions, reducing unnecessary interventions.
Cinematic Rendering in Pancreatic Imaging: Tackling the CT Patterns of Serous Cystadenoma.
Rahmatullah ZF, Krueger S, Soyer P, Chu LC, Fishman EK.
Canadian Association of Radiologists Journal. 2026;0(0). doi:10.1177/08465371251413558 - Serous cystadenoma (SCA), comprising 16% of pancreatic cysts, is the most common benign pancreatic lesion, characterized by glycogen-rich epithelial cells forming numerous small, fluid-filled cysts. SCAs are most often seen in women aged between 60 and 80 years and are more frequently observed in the pancreatic body and tail (60%) compared to the head (40%). Often detected incidentally on imaging, as up to 60%of patients remain asymptomatic, patients with SCAs can present with non-specific symptoms such as abdominal pain, abdominal mass, and, rarely, jaundice. SCAs are traditionally found as single lesions in the pancreas, but in patients with von Hippel-Lindau disease, they may occur as multiple lesions.
Cinematic Rendering in Pancreatic Imaging: Tackling the CT Patterns of Serous Cystadenoma.
Rahmatullah ZF, Krueger S, Soyer P, Chu LC, Fishman EK.
Canadian Association of Radiologists Journal. 2026;0(0). doi:10.1177/08465371251413558 - The use of advanced pancreatic imaging, including three dimensional(3D) imaging techniques, shows promise in bridging this diagnostic gap. Cinematic rendering (CR) is a novel 3D CT imaging technique that produces photorealistic images with enhanced texture mapping and improved visualization of anatomical details compared to traditional two-dimensional (2D) and other 3D reconstructions. This superior representation of textural differences between lesions has proven helpful in both detecting and differentiating pancreatic neoplasms. To the best of our knowledge, the 3D CR imaging features of SCAs and the role CR can potentially play in differentiating between the different variants of SCAs have not been previously described in the literature. It is of note that there is a lack of direct statisticalevidence and comparative studies on the clinical impact and accuracy of CR.
Cinematic Rendering in Pancreatic Imaging: Tackling the CT Patterns of Serous Cystadenoma.
Rahmatullah ZF, Krueger S, Soyer P, Chu LC, Fishman EK.
Canadian Association of Radiologists Journal. 2026;0(0). doi:10.1177/08465371251413558 - The CR implementation used in our reading software includes specialized presets dedicated to imaging different organs, including configurations tailored specifically for pancreatic assessment. These presets can be further adjusted to enhance textures, transparency levels, and improve tumor detection. At our center, CR is routinely employed for the evaluation of pancreatic lesions because it provides a comprehensive view of pancreatic morphology and increased tissue contrast can facilitate more accurate classification of cystic neoplasms. Furthermore, it offers a stunningly detailed and lifelike visualization of blood vessels, enhancing the clarity and depth of vascular anatomy. Drawing on extensive experience, we have developed optimized rendering parameters tailored for pancreatic pathology. These settings are fine-tuned in real time on a case-by-case basis to ensure optimal visualization of the pathology.
Cinematic Rendering in Pancreatic Imaging: Tackling the CT Patterns of Serous Cystadenoma.
Rahmatullah ZF, Krueger S, Soyer P, Chu LC, Fishman EK.
Canadian Association of Radiologists Journal. 2026;0(0). doi:10.1177/08465371251413558 - A central scar, with or without a stellate calcification pattern, is seen on CT in up to 30% of SCAs and is considered highly suggestive of an SCA.5 Through improved tissue contrast and accentuation of subtle enhancement patterns, CR allows better characterization of heterogeneous lesions, including that of a central scar ,while adjustable window width and level facilitate identification of cystic components and septations. Furthermore, CR can be tailored to highlight structures across a range of Hounsfield units, allowing for separate depiction of any associated vascularity or calcifications unlike standard 2D imaging. The same applies to surrounding vessels, which can clearly be seen to be stretched by the mass on CR.
Cinematic Rendering in Pancreatic Imaging: Tackling the CT Patterns of Serous Cystadenoma.
Rahmatullah ZF, Krueger S, Soyer P, Chu LC, Fishman EK.
Canadian Association of Radiologists Journal. 2026;0(0). doi:10.1177/08465371251413558 - The honeycomb pattern of SCAs is defined by the presence of numerous tiny cysts that are often difficult to distinguish individually, giving the lesion a sponge-like appearance due to the intervening connective tissue septa. This pattern accounts for around 20% of all SCAs and presents as soft tissue or mixed attenuation masses on standard imaging, depending on the size of the cysts and the proportion of enhancing fibrous tissue. CR improves confidence in diagnosis by clearly highlighting internal septations and enhancing the illustration of internal architecture, including any vascularity, calcification, and cystic spaces through the addition of greater textural detail which can be missed with conventional imaging.
Cinematic Rendering in Pancreatic Imaging: Tackling the CT Patterns of Serous Cystadenoma.
Rahmatullah ZF, Krueger S, Soyer P, Chu LC, Fishman EK.
Canadian Association of Radiologists Journal. 2026;0(0). doi:10.1177/08465371251413558 - The macrocystic variety, also called oligocystic, is uncommon, seen in less than 10% of SCAs. It appears as a unilocular cyst or a mass composed of fewer but larger (ie, >2 cm) cysts without a central stellate scar. Macrocystic SCAs in particular are commonly confused with other pancreatic cystic lesions such as intraductal papillary mucinous neoplasms and mucinous cystic neoplasms, however, lack of wall enhancement and the presence of external lobulations help differentiate them. CR complements standard 2D imaging by precisely distinguishing lesion boundaries from the normal pancreatic parenchyma, thereby identifying the source of the mass. Additionally, textural visualization in CR supports the identification of the homogeneous nature of macrocystic SCAs,facilitating diagnosis and detecting any septations that might bemissed on standard 2D imaging .
Cinematic Rendering in Pancreatic Imaging: Tackling the CT Patterns of Serous Cystadenoma.
Rahmatullah ZF, Krueger S, Soyer P, Chu LC, Fishman EK.
Canadian Association of Radiologists Journal. 2026;0(0). doi:10.1177/08465371251413558 - However, some SCAs may not be entirely solid; instead, they can appear solid on imaging while containing cystic components, resulting in a mixed appearance. In such cases, CR assists in distinguishing solid from cystic pancreatic neoplasms by enhancing spatial perception and enabling detailed assessment of internal features, such as mural nodularity within cystic lesions. Clinically, however, these lesions remain challenging to diagnose and are often misclassified as solid pseudopapillary neoplasms, pancreatic ductal adenocarcinomas, metastatic carcinomas, or, most commonly, pancreatic neuroendocrine tumors.
Cinematic Rendering in Pancreatic Imaging: Tackling the CT Patterns of Serous Cystadenoma.
Rahmatullah ZF, Krueger S, Soyer P, Chu LC, Fishman EK.
Canadian Association of Radiologists Journal. 2026;0(0). doi:10.1177/08465371251413558 
- “Pancreatic SCAs exhibit a wide range of imaging appearances on CT, making it challenging to establish a confident diagnosis. Familiarity with their diverse patterns and atypical features is essential for accurately distinguishing them from other cystic and solid pancreatic lesions. CR offers valuable support to regular CT imaging by creating detailed 3D reconstructions that enhance visualization and assessment of various types of SCAs. It is unparalleled when evaluating the external margins, internal components, associated vasculature, and neighboring structures. This advanced imaging technique aids radiologists in better differentiating lesions and while studies are still needed to evaluate its impact on diagnostic confidence, it has the potential to lead to more accurate diagnoses and improved patient care.”
Cinematic Rendering in Pancreatic Imaging: Tackling the CT Patterns of Serous Cystadenoma.
Rahmatullah ZF, Krueger S, Soyer P, Chu LC, Fishman EK.
Canadian Association of Radiologists Journal. 2026;0(0). doi:10.1177/08465371251413558
- “SCAs are benign cystic neoplasms characterized by glycogen-rich epithelial cells forming multiple small thin walled cysts that contain serous fluid. They usually occur sporadically but have an increased incidence in von Hippel–Lindau syndrome (VHL). While frequently found incidentally and usually asymptomatic, larger lesions (>4 cm) can cause non- specific symptoms [5, 6], including abdominal pain, palpable abdominal mass, and rarely jaundice. Most lesions (60%) occur in the pancreatic body and tail, with the remaining 40% seen in the pancreatic head and uncinate process. SCAs show a predilection for middle-aged and older women and are less commonly seen in males.”
Imaging of pancreatic serous cystadenoma and common imitators
Camila Lopes Vendrami · Nancy A. Hammond · David J. Escobar et al.
Abdominal Radiology (2024) 49:3666–3685 - “The solid variant is an extremely rare type of SCAs and is also known as solid serous adenoma. This variant has variable definitions in the literature with some authors basing their definition on a microscopic appearance, while others use a solid radiologic appearance for diagnosis. Solid variant SCAs are formed by cells that resemble those from other forms of SCA but do not contain cystic spaces in histopathology. This is in distinction to other variants of SCAs that can have a solid appearance on imaging but demonstrate cystic spaces on histopathology. On imaging, the solid variant is difficult to distinguish from other solid pancreatic lesions such as pancreatic neuroendocrine tumors or other solid lesions such as metastatic renal cell carcinoma.”
Imaging of pancreatic serous cystadenoma and common imitators
Camila Lopes Vendrami · Nancy A. Hammond · David J. Escobar et al.
Abdominal Radiology (2024) 49:3666–3685 - “VHL-associated serous cystic neoplasm (WHO classification) present with lesions that are indiscernible at histology from sporadically occurring serous cystic tumors. VHL is a multi-tumor inherited autosomal dominant disease. VHL is caused by mutations in the VHL tumor suppressor gene and is characterized by the presence of hemangioblastoma of the central nervous system and retina, adrenal pheochromocytoma, renal cell carcinoma (RCC), pancreatic neuroendocrine tumors and cysts, cystadenomas, and mixed tumors, and other organ involvement . In VHL disease, almost 7.6% of patients may have pancreatic manifestations alone, while 11.5% of patients show combined lesions.”
Imaging of pancreatic serous cystadenoma and common imitators
Camila Lopes Vendrami · Nancy A. Hammond · David J. Escobar et al.
Abdominal Radiology (2024) 49:3666–3685 - “Chu et al. demonstrated equivalent performance between their radiomics-based model and an experienced radiologist in the accurate classification of several pancreatic cystic lesions (SCAs, MCNs, SPNs, and NETs) with an AUC of 0.94 for the AI-based approach and 0.895 for the radiologist. The documented imaging features were size and location of pancreatic cysts and presence of calcifications or pancreatic duct dilatation (>3 mm in diameter). A total of 488 radiomics features from the segmented three-dimensional (3D) volume of the cystic lesion were extracted based on venous phase images. Although more validation is still needed, the ability of AI to accurately characterize pancreatic cystic lesions can potentially improve the selection of patients with high-risk lesions who would benefit from surgical intervention, while separating out those who can be managed more conservatively.”
Imaging of pancreatic serous cystadenoma and common imitators
Camila Lopes Vendrami · Nancy A. Hammond · David J. Escobar et al.
Abdominal Radiology (2024) 49:3666–3685 - “Cystic PNETs can occur due to large solid tumors that have undergone cystic degeneration or more recently, a smaller cystic subtype of PNET has been identified. This subtype occurs mostly in the pancreatic body and tail, demonstrates less aggressive behavior (lower ki-67 index), are nonfunctioning, and are associated with a lower rate of metastases. The most suggestive radiologic feature of cystic PNETs is the hypervascular peripheral wall . Additionally, clinical history of endocrinopathy, and associated lymphadenopathy and liver metastases are helpful characteristics to differentiate PNETs from SCAs.”
Imaging of pancreatic serous cystadenoma and common imitators
Camila Lopes Vendrami · Nancy A. Hammond · David J. Escobar et al.
Abdominal Radiology (2024) 49:3666–3685 - “Pancreatic serous cystadenoma are mostly benign tumors that can be managed conservatively with surveillance unless they demonstrate aggressive behavior or unspecific features that prevent proper pre-operative diagnosis. In blinded studies, radiologists could diagnose SCAs relatively well (23–82% of cases). SCAs classically appear as multiple small cysts leading to a multilobulated external contour that does not usually occur in other cystic lesions, known as microcystic pattern, and that may allow differentiation from other types of pancreatic tumors possible. However, SCAs may also depict a wide range of imaging appearances ranging from a unilocular cystic lesion to a solid hypervascular mass that may overlap with other pancreatic neoplasms. Cyst fluid analysis with immunohistochemistry and molecular characterization may assist in the preoperative risk stratification. Newer imaging techniques may also playa role in the discrimination of SCAs and their mimickers.”
Imaging of pancreatic serous cystadenoma and common imitators
Camila Lopes Vendrami · Nancy A. Hammond · David J. Escobar et al.
Abdominal Radiology (2024) 49:3666–3685
- “Pancreatic cystic neoplasms are lesions comprised of cystic components that show different biological behaviors, epidemiology, clinical manifestations, imaging features, and malignant potential and management. Benign cystic neoplasms include serous cystic neoplasms (SCAs). Other pancreatic cystic lesions have malignant potential, such as intraductal papillary mucinous neoplasms and mucinous cystic neoplasms. SCAs can be divided into microcystic (classic appearance),honeycomb, oligocystic/macrocystic, and solid patterns based on imaging appearance. They are usually solitary but may be multiple in von Hippel–Lindau disease, which may depict disseminated involvement. The variable appearances of SCAs can mimic other types of pancreatic cystic lesions, and cross-sectional imaging plays an important role in their differential diagnosis. Endoscopic ultrasonography has helped in improving diagnostic accuracy of pancreatic cystic lesions by guiding tissue sampling (biopsy) or cyst fluid analysis. Immunohistochemistry and newer techniques such as radiomics have shown improved performance for preoperatively discriminating SCAs and their mimickers.”
Imaging of pancreatic serous cystadenoma and common imitators
Camila Lopes Vendrami · Nancy A. Hammond · David J. Escobar
Abdominal Radiology 2024 (in press) - “While frequently found incidentally and usually asymptomatic, larger lesions (>4 cm) can cause non- specific symptoms, including abdominal pain, palpable abdominal mass, and rarely jaundice. Most lesions (60%) occur in the pancreatic body and tail, with the remaining 40% seenin the pancreatic head and uncinate process. SCAs show a predilection for middle-aged and older women and are less commonly seen in males. In contrast, mucinous cystic neoplasms are almost exclusively seen in females and contain ovarian stroma. SCAs are sub-classified by the 2019 World Health Organization (WHO) Digestive System Tumor Classification as microcystic serous cystadenoma, oligocystic/macrocystic serous cystadenoma, solid serous adenoma, Von Hippel–Lindau (VHL) syndrome-associated serous cystic neoplasm, and mixed serous-neuroendocrine neoplasm. While SCAs are overwhelmingly considered benign lesions and clinically managed as such, a few rare cases have been reported in the literature that have undergone malignant degeneration. One study consisting of 2622 cases reported only three cases of serous cystadenocarcinomas.”
Imaging of pancreatic serous cystadenoma and common imitators
Camila Lopes Vendrami · Nancy A. Hammond · David J. Escobar
Abdominal Radiology 2024 (in press) - “VHL-associated serous cystic neoplasm (WHO classification) present with lesions that are indiscernible at histology from sporadically occurring serous cystic tumors . VHL is a multi-tumor inherited autosomal dominant disease . VHL is caused by mutations in the VHL tumor suppressor gene and is characterized by the presence of hemangioblastoma of the central nervous system and retina, adrenal pheochromocytoma, renal cell carcinoma (RCC), pancreatic neuroendocrine tumors and cysts, cystadenomas, and mixed tumors, and other organ involvement. In VHL disease, almost 7.6% of patients may have pancreatic manifestations alone, while 11.5% of patients show combined lesions. In VHL patients, serous cystic neoplasms can be focal or replace the pancreas diffusely. Most commonly, these lesions show the classical microcystic cystadenoma appearance or the oligocystic/macrocystic variant features. Solid pancreatic tumors occur in <20% of VHL patients, mostly PNETs, however, some benign pancreatic cysts that are microcysts can be organized architecturally in such a dense manner that they can mimic PNETs on imaging, though this is rare.”
Imaging of pancreatic serous cystadenoma and common imitators
Camila Lopes Vendrami · Nancy A. Hammond · David J. Escobar
Abdominal Radiology 2024 (in press) - “The oligocystic/macrocystic pattern accounts for less than 10% of cases of SCAs. This variant may be a single unilocular cyst or a lesion comprised of several larger (>2 cm) Unlike the microcystic variant, the oligocystic/macrocystic form does not have a central scar but does show external lobulations like microcystic SCAs. These lesions also occur more frequently in the pancreatic head. If the lesion is large enough, these patients may present with jaundice or common bile duct obstruction. The differential diagnosis for oligocystic/macrocystic SCA includes solid pseudopapillary tumor, pseudocyst, and mucinous cystic neoplasm. The external lobulations of SCAs can aid in distinguishing between mucinous cystic neoplasms and IPMNs. Dilatation of the pancreatic duct is only seen in rare cases cysts than seen with the microcystic variant.”
Imaging of pancreatic serous cystadenoma and common imitators
Camila Lopes Vendrami · Nancy A. Hammond · David J. Escobar
Abdominal Radiology 2024 (in press) - “The solid variant is an extremely rare type of SCAs and is also known as solid serous adenoma. This variant has variable definitions in the literature with some authors basing their definition on a microscopic appearance, while others use a solid radiologic appearance for diagnosis. Solid variant SCAs are formed by cells that resemble those from other forms of SCA but do not contain cystic spaces in histopathology . This is in distinction to other variants of SCAs that can have a solid appearance on imaging but demonstrate cystic spaces on histopathology. On imaging, the solid variant is difficult to distinguish from other solid pancreatic lesions such as pancreatic neuroendocrine tumors or other solid lesions such as metastatic renal cell carcinoma.”
Imaging of pancreatic serous cystadenoma and common imitators
Camila Lopes Vendrami · Nancy A. Hammond · David J. Escobar
Abdominal Radiology 2024 (in press) - “Chu et al. demonstrated equivalent performance between their radiomics-based model and an experienced radiologist in the accurate classification of several pancreatic cystic lesions (SCAs, MCNs, SPNs, and NETs) with an AUC of 0.94 for the AI-based approach and 0.895 for the radiologist. The documented imaging features were size and location of pancreatic cysts and presence of calcifications or pancreatic duct dilatation (>3 mm in diameter). A total of 488 radiomics features from the segmented three-dimensional (3D) volume of the cystic lesion were extracted based on venous phase images. Although more validation is still needed, the ability of AI to accurately characterize pancreatic cystic lesions can potentially improve the selection of patients with high-risk lesions who would benefit from surgical intervention, while separating out those who can be managed more conservatively.”
Imaging of pancreatic serous cystadenoma and common imitators
Camila Lopes Vendrami · Nancy A. Hammond · David J. Escobar
Abdominal Radiology 2024 (in press) - “SCAs are associated with somatic or germline VHL gene mutations on chromosome 3p25. In addition, the presence of VHL mutation with TP53 or TERT promoter mutations corresponds with interval growth in size in SCAs. The presence of a VHL mutation combined with the lack of a KRAS, GNAS, or RNF43 mutations (commonly identified in mucinous cystic neoplasms and pancreatic ductal adenocarcinoma) have a sensitivity of 71–100% and specificity of 91–100% for accurately preoperatively detecting SCA. SCAs also lack CTNNB1 mutations that are specific for solid pseudopapillary neoplasm (SPN).’
Imaging of pancreatic serous cystadenoma and common imitators
Camila Lopes Vendrami · Nancy A. Hammond · David J. Escobar
Abdominal Radiology 2024 (in press) - “Benign squamoid cyst of pancreatic duct is a rare cystic lesion of the pancreas first described in 2007. These cysts are the result of unilocular cystic dilatation of pancreatic ducts and have variable linings (from attenuated, flat, non-stratified squamous, to transitional, to mucosaltype stratified squamous epithelium without a cornified layer or parakeratosis). These lesions are typically relatively small cysts, with a median size of 1.5 cm. These lesions are difficult to distinguish from other pancreatic cystic lesions and most cases of benign squamoid cyst of pancreatic duct are proven after surgical resection. However, the presence of squamous epithelium in cytologic samples obtained by EUS may suggest this entity and help avoid unnecessary resection.”
Imaging of pancreatic serous cystadenoma and common imitators
Camila Lopes Vendrami · Nancy A. Hammond · David J. Escobar
Abdominal Radiology 2024 (in press)
- Serous cystadenoma (SCA) is a benign cystic pancreatic neoplasm of the pancreas, accounting for approximately 15% of resected pancreatic cysts. Current recommendations are to proceed with surgical resection in symptomatic patients or when there is uncertainty regarding diagnosis. The latter continues to be a challenge since intentional resection of a serous cystadenoma account for only a minority of resected of cases.
Pancreatic Serous Cystadenoma: A Continuing Diagnostic Challenge.
Assawasirisin, Charnwit et al.
Annals of Surgery ():10.1097/SLA.0000000000006203, January 17, 2024 - “A total of 250 patients were analyzed. Median age was 62 (range 22 – 89), 65% were female, and 34% had symptoms. Tumor size ranged from 0.6 to 20, with a median of 3.4 cm. The morphological appearance was microcystic in 58%, macrocystic in 16%, mixed-type in 23%, and solid in 3%. Pancreatic duct dilation and pancreatic atrophy were found in 22% and 14%, respectively. The average growth rate was 1.8 mm/year regardless of tumor size. Of the 172 patients who underwent surgery, serous cystadenoma was the preoperative diagnosis in only 33%. A correct diagnosis was independently associated with large tumors and cyst fluid CEA analysis. Pancreatic duct dilation was independently associated with an in-growing cyst and presence of calcification.”
Pancreatic Serous Cystadenoma: A Continuing Diagnostic Challenge.
Assawasirisin, Charnwit et al.
Annals of Surgery ():10.1097/SLA.0000000000006203, January 17, 2024 - “SCA is a slow-growing pancreatic cystic neoplasm that is mostly asymptomatic but can lead to pancreatic duct dilation and atrophy in some patients. A surprisingly small number of correct preoperative diagnoses confirms that this entity continues to be a diagnostic challenge. A more thorough preoperative workup that includes EUS should improve the rate of mis-diagnosis..”
Pancreatic Serous Cystadenoma: A Continuing Diagnostic Challenge.
Assawasirisin, Charnwit et al.
Annals of Surgery ():10.1097/SLA.0000000000006203, January 17, 2024