Pancreatic Pathology Online

Pathology of Cystic Tumours of the Pancreas

Dr Sampurna Roy MD                     July 2016


Non-Neoplastic Pancreatic Cysts including Congenital and Pseudocysts

Dermoid Cyst (Cystic Teratoma)


Benign tumours of the exocrine pancreas are rare.

The most common one, which presents as a large cystic tumour, deserves mention because it is important that it be differentiated diagnostically from the various congenital and acquired cysts that are not true neoplasms.  Difficulties of differential diagnosis of pancreatic pseudocysts and cystic neoplasms.

Cystic tumours constitute fewer than 5% of pancreatic neoplasms.

Tumours are usually located in the body or tail and present as painless, slow-growing masses.

1. Serous microcystic adenoma: Predominantly in women older than age 65.

Tumours are usually solitary, 6 to 10 cm in diameter, well circumscribed, and round.

Tumours are made up of numerous tiny cysts.

A few larger ones are filled with serous, clear, watery fluid and lined with a bland serous epithelium.

Sometimes there is a central fibrous core.

Prognosis is excellent, with little risk of malignant transformation.

2. Mucinous cystic tumour:

Unilocular or multuloculated cystic neoplasms upto 10 cm in diameter filled with mucinous material and lined by mucin-producing tall columnar cells (except when compressed into a flattened epithelium).

These are usually noted in women and may vary from benign (cystadenoma) to borderline to malignant (cystadenocarcinoma), on the basis of epithelial pleomorphism and evidence of invasion and metastasis.

Prognosis depends on adequacy of surgical resection.

Cystadenoma of the pancreas are large, multiloculated, cystic tumours, usually localized in the body or tail.

They occur most frequently in women between age 50 and 70.

Cystadenomas, which constitute about 10% of cystic lesions of the pancreas, are of two types, depending on whether they are lined by serous or mucinous epithelium.

Serous cystadenomas consist of numerous cysts of varying size, lined by a cuboidal epithelium with a clear glycogen-rich cytoplasm.

The microcystic variant consists of uniformly small cysts, which on gross examination appear as solid tumour.

Mucinous cystadenomas are composed of multiloculated cysts lined by a high columnar epithelium that secretes mucin.

Both variants of this tumour are thought to originate from the pancreatic duct system, the serous from ductular cells and mucinous from cells lining the larger ducts.

Since pancreatic ductal adenocarcinomas are frequently both well differentiated and mucin-producing, it is important that biopsy of mucinous cystadenomas yield sufficient tissue to ensure that it is not a ductal adenocarcinoma that has undergone central necrosis and cystic change.

Cystic neoplasms of the pancreas--cystadenomas and cystadenocarcinomas.


3. Solid-cystic papillary cystic tumour:

A round, well-circumscribed tumour with solid and cystic regions.

The cystic areas are primarily due to hemorrhage and cystic degeneration.

Tumour cells are small and uniform, growing in solid sheets or papillary projections.

Tumours are seen in adolescent girls and women younger than 35 years of age.

Prognosis is usually excellent, although metastases can occur.



Further reading:

Pancreatic cystic neoplasms.

Cystic lesions in the pancreas: when to watch, when to resect.

Cystic neoplasms of the pancreas; what a clinician should know.

Cystic neoplasms of the pancreas: a diagnostic challenge.

Cystic neoplasms of the pancreas; what a clinician should know.

Cystic tumours of the pancreas: diagnostic accuracy, pathologic observations and surgical consequences. 

Cystic neoplasms of the pancreas--a review.

Cystic neoplasms and true cysts of the pancreas.

Cystic pancreatic neoplasms: 12-year surgical experience.

Cystic tumors of the pancreas.

Cyst fluid analysis in the differential diagnosis of pancreatic cystic lesions: a pooled analysis.




Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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