Natural history and growth prediction model of pancreatic serous cystic neoplasms.

OBJECTIVE: Serous cystic neoplasms (SCN) are benign pancreatic cystic neoplasms that may require resection based on local complications and rate of growth. We aimed to develop a predictive model for the growth curve of SCNs to aid in the clinical decision making of determining need for surgical resection. METHODS: Utilizing a prospectively maintained pancreatic cyst database from a single institution, patients with SCNs were identified. Diagnosis confirmation included imaging, cyst aspiration, pathology, or expert opinion. Cyst size diameter was measured by radiology or surgery. Patients with interval imaging ≥3 months from diagnosis were included. Flexible restricted cubic splines were utilized for modeling of non-linearities in time and previous measurements. Model fitting and analysis were performed using R (V3.50, Vienna, Austria) with the rms package. RESULTS: Among 203 eligible patients from 1998 to 2021, the mean initial cyst size was 31 mm (range 5-160 mm), with a mean follow-up of 72 months (range 3-266 months). The model effectively captured the non-linear relationship between cyst size and time, with both time and previous cyst size (not initial cyst size) significantly predicting current cyst growth (p < 0.01). The root mean square error for overall prediction was 10.74. Validation through bootstrapping demonstrated consistent performance, particularly for shorter follow-up intervals. CONCLUSION: SCNs typically have a similar growth rate regardless of initial size. An accurate predictive model can be used to identify rapidly growing outliers that may warrant surgical intervention, and this free model (https://riskcalc.org/SerousCystadenomaSize/) can be incorporated in the electronic medical record.

Mullerian Serous Cystadenoma Occurring in the Scrotum Post-Orchidopexy: A Rarely Reported Yet Distinctive Entity.

Serous cystadenoma is a rare lesion in the para-testicular tissue, with even rarer reports of this entity occurring in the scrotum post-orchidopexy. We present such an occurrence, adding support for its existence as a distinct entity.

Coexisting ovarian serous cystadenoma with fibroma: A very unusual combination.

Surface epithelial neoplasms are the most common ovarian tumors, constituting around 60% of all ovarian malignancies. They are classified as benign, borderline, and malignant. Ovarian cystadenomas are common benign epithelial neoplasms which carry an excellent prognosis. Ovarian thecoma-fibroma groups are uncommon sex cord-stromal neoplasms, constituting 1.0%-4.0% of all ovarian tumors. Most of them are benign and often found in postmenopausal patients. Combination tumors in the ovary are known. The most common combination is mucinous cystadenoma which occurs in association with Brenner tumor, mature cystic teratoma, Sertoli-Leydig cell tumor, or even a serous cystadenoma. A combination of surface epithelial and thecoma-fibroma group is very rarely encountered. A case of one such combination of serous cystadenoma and fibroma of the ovary is being presented here in a postmenopausal woman.

Increased Uptake in Microcystic Serous Cystadenoma Mimicking Pancreatic Neuroendocrine Tumor on 68 Ga-DOTATATE PET/MRI.

ABSTRACT: A 2.6-cm solid cystic lesion in the pancreatic head was found in a 51-year-old woman on CT. A pancreatic neuroendocrine tumor was suspected, and a 68 Ga-DOTATATE PET/MRI was performed, which showed increased tracer uptake in the lesion. However, postsurgical pathologic examination indicated a pancreatic serous cystadenoma. Here, we reported a case of microcystic pancreatic serous cystadenoma that could be misdiagnosed as a pancreatic neuroendocrine tumor on a 68 Ga-DOTATATE PET/MRI.

Extracellular vesicle analysis of plasma allows differential diagnosis of atypical pancreatic serous cystadenoma.

Increased use of cross-sectional imaging has resulted in frequent detection of incidental cystic pancreatic lesions. Serous cystadenomas (SCAs) are benign cysts that do not require surgical intervention unless symptomatic. Unfortunately, up to half of SCAs do not have typical imaging findings ("atypical SCAs"), overlap with potentially malignant precursor lesions, and thus pose a diagnostic challenge. We tested whether the analysis of circulating extracellular vesicle (EV) biomarkers using a digital EV screening technology (DEST) could enhance the discrimination of cystic pancreatic lesions and avoid unnecessary surgical intervention in these atypical SCAs. Analysis of 25 different protein biomarkers in plasma EV from 68 patients identified a putative biomarker signature of Das-1, Vimentin, Chromogranin A, and CAIX with high discriminatory power (AUC of 0.99). Analysis of plasma EV for multiplexed markers may thus be helpful in clinical decision-making.

Serous cystadenoma of head pancreas masquerading as pancreatic neuroendocrine tumor: Treated by Whipple's pancreaticoduodenectomy.

Serous cystadenoma (SCA) is the most common cystic neoplasm of the pancreas. Serous cystadenoma is best diagnosed by imaging with computed tomography scan. Fine-needle aspiration cytology is required for definitive preoperative diagnosis. Serous cystadenoma may be sometime difficult to differentiate from pancreatic neuroendocrine tumor (PNET) in the preoperative stage. Differentiating the two entities are important for proper treatment strategy. Serous cystadenoma may be managed in expectant observation. However, all PNETs will need surgical treatment including pancreaticoduodenectomy (PD). Here, we present a rare presentation of serous cystadenoma head of pancreas masquerading as PNET with local compressive symptoms for which Whipple's PD was done successfully.

A case of serous cystic neoplasm with tumor growth acceleration leading to extrapancreatic invasion.

Serous cystic neoplasm (SCN) is a potentially malignant and invasive disease. However, there are no established guidelines regarding the surgical management of SCN. Here, we report a case of SCN with jejunal invasion that ultimately required a distal pancreatectomy with partial resection of the jejunum. The patient was a 65-year-old female who was referred to our department after a diagnosis of SCN in the pancreatic tail. CT and MRI showed a 75-mm multifocal cystic mass with calcifications; the splenic vein and left adrenal vein were entrapped within the tumor. Furthermore, the tumor was in contact with the beginning of the jejunum. Finally, she underwent a posterior radical antegrade modular pancreatosplenectomy with a partial wedge-shaped resection of the jejunum. Histological findings indicated serous cystadenoma. In addition, the tumor cells were found to have infiltrated the jejunal muscularis propria in some areas, suggesting that the tumor had malignant potential. Currently, 14 months have passed since surgery and there is no evidence of metastasis or recurrence. Surveillance and the decision to perform surgical resection should be made based on tumor size and growth rate to avoid malignant transformation as well as to provide SCN patients with organ-sparing, less invasive surgery.

"Evolving Trends in Pancreatic Cystic Tumors: A 3-Decade Single-Center Experience With 1290 Resections".

OBJECTIVE: The aim of this study was to describe our institutional experience with resected cystic tumors of the pancreas with emphasis on changes in clinical presentation and accuracy of preoperative diagnosis. SUMMARY BACKGROUND DATA: Incidental discovery of pancreatic cystic lesions has increased and has led to a rise in pancreatic resections. It is important to analyze surgical outcomes from these procedures, and the prevalence of malignancy, pre-malignancy and resections for purely benign lesions, some of which may be unintended. METHODS: Retrospective review of a prospective database spanning 3 decades. Presence of symptoms, incidental discovery, diagnostic studies, type of surgery, postoperative outcomes, and concordance between presumptive diagnosis and final histopathology were recorded. RESULTS: A total of 1290 patients were identified, 62% female with mean age of 60 years. Fifty-seven percent of tumors were incidentally discovered. Ninety-day operative mortality was 0.9% and major morbidity 14.4%. There were 23 different diagnosis, but IPMN, MCN, and serous cystadenoma comprised 80% of cases. Concordance between preoperative and final histopathological diagnosis increased by decade from 45%, to 68%, and is presently 80%, rising in parallel with the use of endoscopic ultrasound, cytology, and molecular analysis. The addition of molecular analysis improved accuracy to 91%. Of misdiagnosed cases, half were purely benign and taken to surgery with the presumption of malignancy or premalignancy. The majority of these were serous cystadenomas. CONCLUSIONS: Indications and diagnostic work-up of cystic tumors of the pancreas have changed over time. Surgical resection can be performed with very low mortality and acceptable morbidity and diagnostic accuracy is presently 80%. About 10% of patients are still undergoing surgery for purely benign lesions that were presumed to be malignant or premalignant. Further refinements in diagnostic tests are required to improve accuracy.

A rare case of pancreatic macrocystic serous cystadenoma in an adolescent: a case report and literature review.

While serous cystadenomas of the pancreas usually consist of small cysts, one rare variant has been reported to be composed of macrocysts. Herein, we present the case of the youngest patient with macrocystic serous cystadenoma (MSC) to be reported in the literature. The patient was a 17-year-old girl who presented with the major symptoms of a palpable abdominal mass accompanied by epigastric pain and vomiting for several months. A potential malignancy could not be excluded on the basis of imaging studies, which showed a large macrocystic pancreatic tumor that was 7 cm in diameter. Owing to the patient's symptoms, after diagnosing the mass as a pancreatic cystic tumor with potential malignancy and large tumor size, surgical intervention was arranged. Pathological analysis of the biopsy sample suggested MSC. By reviewing the literature, we found several unique characters of MSCs that cause them to be frequently misdiagnosed as potential malignancies. Additionally, the age of MSC occurrence was found to be lower than of general serous cystadenomas. The potential of MSC should be kept in mind by clinicians when diagnosing young people with pancreatic macrocystic lesions.

[A rare variant of pancreatic serous cystadenoma]. / Redkii variant seroznoi tsistadenomy podzheludochnoi zhelezy.

The authors present a patient with serous cystadenoma of the pancreatic head. Atypical symptoms and CT data did not allow excluding pancreatic cancer. Thus, pancreaticoduodenectomy was performed.

Multiple Intraabdominal and Pelvic Cystadenomas From Ovarian Remnant Syndrome.

Serous cystadenomas are benign epithelial neoplasms of the ovary, and they typically have an average size of around 10 cm. Our patient is a 68-year-old female who originally presented with abdominal page. Our patient's prior surgical history includes a bilateral salpingo-oophorectomy. Computed tomography scans showed five abdominal and pelvic masses of significant size. Our patient elected to undergo exploratory laparotomy and mass excision, and all five masses were able to be removed successfully. Final pathology confirmed the diagnosis of serous cystadenomas consistent with ovarian origin despite our patient undergoing a previous bilateral salpingo-oophorectomy. Our patient presented with a rare syndrome known as ovarian remnant syndrome that is thought to be caused by difficult hysterectomy procedures and prior abdominal surgeries that can unknowingly leave ovarian remnants. Second, the patient was found to have 5 abdominal and pelvic masses, and most of the masses were a very large size.

SEROUS CYSTADENOMA OF PANCREAS: WHY THERE IS LOW ACCURACY IN IMAGING EXAMS? / CISTOADENOMA SEROSO DE PÂNCREAS. POR QUE A ACURÁCIA É BAIXA AOS EXAMES DE IMAGEM?

AIM: Many patients with serous cystadenoma of the pancreas (SCP) underwent surgery due to diagnostic doubt. The aim of this study was to analyze the causes of low accuracy in diagnosing SCP. METHODS: This is a retrospective study of patients with SCP from a database of two hepatopancreatic biliary surgery outpatient clinics between 2006 and 2020. Patients with typical SCP lesions in imaging exams (e.g., tomography, magnetic resonance imaging [MRI], and endoscopic ultrasound [EUS]) and patients whose pathological testing confirmed this diagnosis were included. RESULTS: A total of 27 patients were included in this study. Most patients were women (85.18%), and the mean age was 63.4 years. Only one patient had typical pancreatitis symptoms. MRI was the most performed method (62.9%). The lesion was single in 88.9%, and the average size was 4 cm. The typical microcystic aspect was found in 66.6%. EUS was performed in 29.6% of cases. The mean carcinoembryonic antigen value in patients undergoing cyst puncture was 198.25 ng/mL. Surgical treatment was performed in 10 cases (37%). The cause of surgery in seven of these cases was due to a suspicion of mucinous cystadenoma based on an identification of atypical lesions (unilocular with or without septa and macrocystic) in imaging exams. A suspicion of intraductal papillary mucinous neoplasm with "worrying factors" was the indication for surgery in two cases. The last case underwent surgical treatment for a solid-looking lesion which was suspected of cancer. The complication rate ≥Clavien-Dindo 2 was 30%, and the clinically relevant pancreatic fistula rate (B and C) was 30%. Mortality was nil. CONCLUSION: The atypical morphological presentation of SCP, particularly unilocular and macrocystic lesions, is the main indication for surgery. Only the implementation of new, efficient, and reproducible diagnostic methods can reduce the number of unnecessary surgeries among these patients.

OBJETIVO: Apesar da recomendação atual que o cistoadenoma seroso deva ser tratado de forma conservadora, significativa parte dos pacientes com essa condição ainda é operada por dúvida diagnóstica. Analisar causas da baixa acurácia diagnóstica do cistoadenoma seroso. MÉTODOS: Estudo retrospectivo de portadores de cistoadenoma seroso de um banco de dados de dois ambulatórios de cirurgia hepatopancreaticobiliar entre 2006 e 2020. Foram incluídos pacientes com lesões típicas de cistoadenoma seroso aos exames de imagem (tomografia computadorizada, ressonância magnética e ecoendoscopia) e pacientes que o anatomopatológico confirmasse esse diagnóstico. RESULTADOS: 27 pacientes foram incluídos. 85,18% eram do sexo feminino. A idade média foi de 63,4 anos. Apenas um apresentava sintomas típicos de pancreatite. A Ressonância magnética foi o exame mais realizado (62,9%). A lesão era única em 88,9% e o tamanho médio foi 4 cm. O aspecto típico microcístico foi encontrado em 66,6% dos casos, os demais foram considerados atípicos. A ecoendoscopia foi realizada em 29,6%. O valor médio de antígeno carcinoembrionário nos pacientes submetidos à punção do cisto foi de 198,25 ng/mL. O tratamento cirúrgico foi realizado em 10 casos (37%). Em 7, a causa cirúrgica foi a suspeita do cistoadenoma mucinoso mediante identificação de lesões atípicas (unilocular com ou sem septos e macrocística). Em 2, a suspeita de neoplasia papilar intraductal mucinosa com "fatores preocupantes" foi a indicação cirúrgica. O último foi submetido à cirurgia por lesão de aspecto sólido e suspeita de câncer. O índice de complicações > ou = Clavien-Dindo 2 foi 30%, o índice de fístula pancreática clinicamente relevante (B e C) foi 30%. A mortalidade foi nula. CONCLUSÃO: A apresentação morfológica atípica do cistoadenoma seroso, particularmente lesões uniloculares e macrocísticas, é a principal responsável pela indicação cirúrgica. Apenas a implementação de novos, eficientes e reprodutíveis métodos diagnósticos poderá reduzir o número de cirurgias desnecessárias nesses pacientes.

The Coexistence of Two Different Epithelial Ovarian Tumors: A Rare Case.

BACKGROUND: Epithelial tumors are the most common subgroup and are seen in 60-70% of all ovarian tumors. Serous cystadenoma and mucinous cystadenoma are the most common benign epithelial tumors. Serous cystadenomas are ovarian tumors with the highest bilateral incidence. The coexistence of tumors with different histopathology in the ovaries is extremely rare and has only been reported in a few cases in the literature. We present a case of bilateral ovarian tumor that was diagnosed as serous and mucinous cystadenoma after laparoscopic surgery. CASE REPORT: A 45-year-old female patient was admitted to our center with swelling in the pelvic region and pain in the left lumbar region. US imaging showed a cystic lesion in the right adnexal area, 4x2 cm in size, well-circumscribed, containing a few thin septa, and a low echo fluid content. A cystic lesion with 6x4cm sized multilocular, well-circumscribed, slightly high echo fluid content was observed in the left adnexal area. On CT, a complex cystic lesion measuring 6x4cm was observed in the left adnexal area, pushing the left ureter laterally and causing the hydroureter. In addition, a 4x2 cm cystic lesion was observed in the right adnexal area and hydroureter was observed on the right side proximal to this lesion. Both lesions were removed by surgery. On histopathologic examination, the left-sided cystic lesion was diagnosed as mucinous cystadenoma, and the right-sided cystic lesion was diagnosed as serous cystadenoma. CONCLUSION: The coexistence of different ovarian tumor subtypes is rare. In this article, we presented a case in which serous and mucinous cystadenoma lesions were seen together for the fourth time in the literature, according to our knowledge.

Non-inflammatory pancreatic cysts: from diagnosis to treatment (97 cases series).

OBJECTIVE: to describe the implications of the diagnosis and treatment of non-inflammatory pancreatic cysts in a series of patients. METHODS: we included patients with pancreatic cysts ≥1.0 cm, excluding those with a presumptive diagnosis of a pseudocyst. Imaging tests, echoendoscopy, and histopathology determined the diagnosis of the type of cyst. We applied the guidelines of the International Association of Pancreatology, with some modifications, in patients with mucinous or indeterminate lesions. RESULTS: 97 adult patients participated in the study. A cystic neoplasm of the pancreas was diagnosed in 82.5% of cases. Diagnosis was mainly made by magnetic resonance (46% of cases). The two most common diagnoses were intraductal papillary mucinous neoplasm (43.3%) and serous cystadenoma (26%). Twenty-nine patients underwent surgery (33.3%). The most common surgical procedure was distal pancreatectomy associated with splenectomy in 19 cases (65.5%). Among the operated patients, 11 were diagnosed with cancer. None of the followed, non-operated patients had a diagnosis of cancer. CONCLUSIONS: magnetic resonance showed good accuracy, particularly in the diagnosis of intraductal papillary mucinous neoplasm. The guidelines of the International Association of Pancreatology, as applied in this study, showed a negative predictive value for cancer of 100%. A development of better diagnostic tests can reduce the number of unnecessary operations.

A case of ovarian serous cystadenofibroma with scattered lesions in pelvic cavity, like malignant disseminations.

Ovarian serous cystadenofibroma is a relatively rare subtype of serous cystadenoma classified as ovarian benign epithelial tumor. We report a rare case of ovarian serous cystadenofibroma with scattered lesions in pelvic cavity, like malignant disseminations. The patient was 22 years old, gravida 0, para 0. In the laparoscopic surgery, numerous hard yellowish-white solid masses of various sizes were present in the bilateral ovaries. Grossly similar masses were scattered in the fimbria of the fallopian tubes, peritoneum, and great omentum. Because the intraoperative rapid histological diagnosis was benign tumor, surgery was completed for only tumor excision. Postoperative histopathological diagnosis is serous cystadenofibroma. Similar pathological findings were noted in the scattered lesions in the peritoneum and great omentum. No malignant or borderline malignant finding was observed. Because of a benign disease, careful treatment taking fertility preservation into consideration is necessary, especially for young patients.