Macrocystic serous cystadenoma of the pancreas - Clinicopathologic features in seven cases

Background. Serous cystic neoplasms of the pancreas are uncommon tumors cla ssified as microcystic adenomas. In this article, the authors report clinic o-pathologic features of seven cases of macrocystic variant of the serous c ystadenoma. Methods. Seven patients (5 females and 2 males) with a diagnosis of cystic lesion of the pancreas were observed after 1995. Clinical, radiological, an d pathologic features, including immunohistochemistry, were reported. Enzym es and tumor markers CEA, CA 19-9, CA 125, CA 15-3, CA 72-4, and mucin-like carcinoma-associated antigen (MCA) were investigated in the serum and cyst fluid of the patients. Cytology was also performed. Results. Six patients were symptomatic complaining abdominal pain. All case s had radiologic evidence of unilocular cyst of the pancreas. The suspected diagnosis was consistent with mucinous cystic neoplasm. Serum tumor marker s were all in the normal range. After surgery, pathology showed in all case s a cyst lined with cuboidal, periodic acid-Schiff (PAS)-positive epirheliu m, without mucin content or atypia. Minute microcysts were found surroundin g the main cavity. Immunohistochemical stains were positive for cytokeratin , CA19-9, CA15-3, CA 72-4, and MCA. CEA was unexpressed. CA 125 in the cyst fluid were found elevated in three cases and CA 19-9 in three cases. Cytol ogy was negative in all cases. Conclusion. When a unilocular pancreatic cyst is found, without history of pancreatitis and gallstones, having low serum tumor markers levels and nega tivity of CA 72-4 and MCA in the cyst fluid, the diagnosis of the macrocyst ic variant of the serous cystadenoma may be suggested. At present, the diag nosis is still based on pathological examination after cyst removal.