Serous cystadenocarcinoma of the pancreas: report of a case and management reflections

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

Serous adenomas represent 1-2% of pancreatic neoplasms and typically are asymptomatic not requiring any treatment and simple observation is the option of choice. Although, they carry a realistic risk of malignancy despite the general view that they never become malignant. We report a case, which, according to our best knowledge is the 27th case reported in the literature.

Methods

We reviewed the literature by performing a search in Pub Med and Medline.

Results

A 86-year old patient known to have a serous cystadenoma of the pancreas treated conservatively through a close clinical and radiological follow up which was unattended for 4 years ending up to our emergency department suffering an acute abdomen. Exploratory laparotomy revealed a perforated prepyloric ulcer which was treated accordingly. Patient died some weeks later due to severe medical co morbidities.

Conclusion

Serous cystic neoplasms of the pancreas carry a realistic risk of malignancy despite the general view that they never become malignant. In our opinion the treatment strategy of serous cystic neoplasms of the pancreas should be aggressive even in cases of remote metastases since prognosis of the disease is satisfactory

Related collections

Most cited references 12

Record: found
Abstract: found
Article: not found

Serous cystadenoma of the pancreas: tumor growth rates and recommendations for treatment.

Andrew Warshaw, Dushyant V Sahani, David Rattner … (2005)

To define the natural history and optimal management of serous cystadenoma of the pancreas. Serous cystadenoma of the pancreas is the most common benign pancreatic neoplasm. Diagnostic criteria, potential for growth or malignancy, and outcomes are not well defined. As a result, management for patients with serous cystadenomas varies widely in current practice. A total of 106 patients presenting with serous cystadenoma of the pancreas from 1976-2004 were identified. Hospital records were evaluated for patient and tumor characteristics, diagnostic workup, treatment, and outcome. Twenty-four patients with serial radiographic imaging were identified, and tumor growth curves calculated. Mean age at presentation was 61.5 years and 75% of patients were female. The most common symptoms were abdominal pain (25%), fullness/mass (10%), and jaundice (7%); 47% were asymptomatic. Mean tumor diameter was 4.9 +/- 3.1 cm, which did not vary by location. Tumors or =4 cm (22% vs. 72%, P or =4 cm (n = 9), the rate was 1.98 cm/y (P = 0.0002). Overall, 86 patients underwent surgery, with one perioperative death. Large (>4 cm) serous cystadenomas are more likely to be symptomatic. Although the median growth rate for this neoplasm is only 0.6 cm/y, it is significantly greater in large tumors. Whereas expectant management is reasonable in small asymptomatic tumors, we recommend resection for large serous cystadenomas regardless of the presence or absence of symptoms.

0 comments Cited 47 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Microcystic adenomas of the pancreas (glycogen-rich cystadenomas): a clinicopathologic study of 34 cases.

J Oertel, Leonard J V Compagno (1978)

Thirty-four cases of microcystic adenoma of the pancreas were studied. These benign tumors have traditionally been classified as cystadenomas, but have not been clearly distinguished from those cystic neoplasms of the pancreas that have a significant malignant potential. Microcystic adenomas are benign, usually large (mean diameter 10.8 cm), and are composed of many tiny cysts lined by small cuboidal cells containing glycogen but little or no mucin. The tumor may be found incidentally at autopsy or, more commonly, may manifest as an abdominal mass with some associated local pain or discomfort. There is no sex predilection. The patients are usually elderly, both mean and median ages being 68. A microcystic pattern is apparent both grossly and microscopically. Electron microscopy confirms the presence of intracytoplasmic glycogen and the epithelial character of the cells. Follow-up data (mean 6.4 years), available in all cases, indicate that when these tumors occur in the head of the pancreas, fatalities may result either from complications of radical surgery or from gastrointestinal or biliary obstruction. When the tumors occur in the body or tail of the pancreas, biopsy alone may be sufficient.

0 comments Cited 45 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Resected serous cystic neoplasms of the pancreas: a review of 158 patients with recommendations for treatment.

Andrew Campbell, Darren Yeo, Charles Galanis … (2007)

Serous cystic neoplasms of the pancreas are regarded as a benign entity with rare malignant potential. Surgical resection is generally considered curative. To perform the largest single institution review of patients who underwent surgical resection for serous cystic neoplasms of the pancreas in the hopes of guiding future management. Between June 1988 and January 2005, 158 patients with serous cystic neoplasms of the pancreas underwent surgical resection. A retrospective analysis was performed. Univariate and multivariate models were used to determine factors influencing perioperative morbidity and mortality. Major complications were defined as pancreatic fistula or anastomotic leak, postoperative bleed, retained operative material, or death. Minor complications were defined as wound infection, postoperative obstruction/ileus requiring total parenteral nutrition (TPN), delayed gastric emptying, arrhythmia, or other infection. The mean age of the patients was 62.1 years, with 75% being female. The majority of patients were symptomatic at presentation (63%), with abdominal pain as the most common symptom. Of the 158 patients, 75 underwent distal pancreatectomy, 65 underwent pancreaticoduodenectomy, nine underwent central pancreatectomy, five underwent local resection or enucleation, and four underwent total pancreatectomy. Mean tumor diameter was 5.1 cm. Mean operative time was 277 min. Mean postoperative length of hospital stay was 11 days. One patient was diagnosed at presentation with serous cystadenocarcinoma. The remaining 157 patients were initially diagnosed with benign serous cystadenoma. One of three patients with locally aggressive benign disease later presented with metastatic disease. Resection margins for all 158 patients were negative for tumor, and only one (0.6%) showed lymph node involvement. There was one intraoperative death. The incidence of major perioperative complications was 18%, whereas the incidence of minor complications was 33%. Men were significantly more likely to experience minor perioperative complications (OR = 3.74, P = 0.008), whereas patients greater than 65 years showed a trend toward fewer major complications (OR = 0.36, P = 0.09). Surgically resected serous cystic neoplasms of the pancreas are typically seen in asymptomatic women as 5 cm neoplasms and are predominantly benign. Most are resected via either a left- or right-sided pancreatectomy with low mortality risk, but with notable major or minor morbidity. Cystadenocarcinoma is a rare finding on initial resection of serous cystic neoplasms. However, initial pathology specimens exhibiting benign but locally aggressive neoplasia may indicate an increased likelihood of recurrence or metachronous metastasis, although this claim is limited by a small patient subpopulation in this study and warrants further review.

0 comments Cited 45 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (nlm-ta): World J Surg Oncol

Journal ID (iso-abbrev): World J Surg Oncol

Title: World Journal of Surgical Oncology

Publisher: BioMed Central

ISSN (Electronic): 1477-7819

Publication date Collection: 2012

Publication date (Electronic): 8 March 2012

Volume: 10

Page: 51

Affiliations

[1 ]LAIKON Hospital, First Department of Surgery, University of Athens Medical School, Greece

[2 ]HPB Surgery, Nicosia Surgical Department, Cyprus

[3 ]Hepatobiliary and Pancreatic Surgical Department, Oxford Radcliffe Hospitals NHS Foundation Trust

[4 ]Churchill Hospital, Oxford, UK

Article

Publisher ID: 1477-7819-10-51

DOI: 10.1186/1477-7819-10-51

PMC ID: 3317835

PubMed ID: 22400805

SO-VID: ca3e5ef3-4e03-4bd8-b30e-f5c805367605

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Serous cystadenocarcinoma of the pancreas: report of a case and management reflections

Read this article at

Abstract

Background

Methods

Results

Conclusion

Related collections

ScienceOpen Clinical Case Reports Collection

Most cited references 12

Serous cystadenoma of the pancreas: tumor growth rates and recommendations for treatment.

Microcystic adenomas of the pancreas (glycogen-rich cystadenomas): a clinicopathologic study of 34 cases.

Resected serous cystic neoplasms of the pancreas: a review of 158 patients with recommendations for treatment.

Author and article information

Journal

Affiliations

Article

History

Categories

Comments

Comment on this article

Similar content 351

Cited by 8

Most referenced authors 166