pancrease benign tumors

Non-Endocrine Neoplasm

Benign Tumors

Serous Cystadenoma• Benign tumors without malignant potential• Very rare (<1%)• Mass effect or rapid growth • 0.45 cm/year – average rate of growth• Asymptomatic and incidental finding 50%• Symptomatic:

– mild upper abdominal pain, epigastric fullness, or moderate weight loss– can grow to a size capable of producing jaundice or GI obstruction due to

mass effect surgical resection • Frequently in older women in which pancreatic resection for a benign

neoplasm should be avoided in the absence of significant symptoms. • All regions of the pancreas are affected.

Serous Cystadenoma

• Spongy appearance, microcystic> macrocystic• Thin serous fluid that does not stain positive for mucin

and is low in CEA (<200 ng/mL)• Typical imaging characteristics:

– well-circumscribed cystic mass– small septations– fluid close to water density– central scar with calcification

• EUS-FNA – Nonviscous fluid with low CEA and amylase levels, – Cells are obtained: cuboidal and have a clear cytoplasm.

Mucinous Cystadenoma

• Benign but potentially malignant carcinoma with a very aggressive behavior

• 6% to 36% - reported to be malignant• Commonly seen in perimenopausal women• 2/3 are located in the body or tail of the pancreas. • Incidental finding • Nonspecific symptoms: upper abdominal discomfort or

pain, early satiety, and weight loss

Mucinous Cystadenoma

• Imaging studies– The cysts have thick walls and do not communicate

with the main pancreatic duct– Nodules or calcifications within the wall of the cyst– Cysts are lined by tall columnar epithelium that fills

the cyst with viscous mucin– Submucosal layer consists of a highly cellular stroma

of spindle cells with elongated nuclei• Elevated CEA levels in the fluid (>200 ng/mL) may

suggest malignant transformation.

Mucinous Cystadenoma• Resection is the treatment of choice: distal pancreatectomy

– Malignant transformation more common with– larger tumors– older patients– stepwise accumulation of mutations (K-ras, p53)

• Small lesions– preserve the spleen– splenectomy ensures removal of the lymph node basin – Important not to rupture the cyst during resection and the tumor should be

removed intact, not morselized. • Prognosis

– Complete resection, without atypia, small (<3cm) – cured– Complete resection with moderate dysplasia or CIST- cured– Invasive carcinoma, mucinous cystadenocarcinoma - dismal

Insert Emi’s Slide

• Thanks