Pancreatic Pathology Online

Pathology of Serous Cystic Tumours of the Pancreas

Dr Sampurna Roy MD             June 2016


Syn: Serous Cystadenoma; Microcystic Adenoma or Cystadenoma ; Glycogen-Rich Cystadenoma.

Cystic tumours of the pancreas are formed by serous or mucinous structures showing all stages of cellular differentiation.

According to the WHO classification, they can be subdivided on the basis of their histological type and biological behavior into benign tumors, borderline tumors, and malignant tumours.

Serous Cystadenoma can be found at any site in the pancreas and occurs more frequently in women.

These tumours are always benign.

It is often an incidental finding on abdominal scans or at autopsy but can present with symptoms and signs of expansile abdominal mass or cause obstruction, example of the common bile duct.

Multifocal examples of this tumor has been reported.

The lesions tend to be relatively large (6-8 cms) and on cut section often show a central stellate scar with a myriad of small surrounding cysts.

Less commonly the cysts are much fewer and larger and these can cause diagnostic confusion at operation.

Whatever the gross appearance, the histological findings are uniform.

The cystic spaces are lined by clear cuboidal cells which can be shown to contain glycogen.

Rarely, the tumours are associated with :

(i) Extra-pancreatic malignant tumours ;

(ii) Hepatic or renal cysts;

(iii) Diabetes mellitus.

Malignant change and metastases are extremely rare.

Serous cystic neoplasms of the pancreas:

Diagram of serous  cystic tumour

Diagram of microcystic adenoma

1) Serous microcystic adenoma:  These microcystic lesions were previously known as "glycogen-rich" cystadenomas because of the presence of glycogen within the cyst epithelium.

-  These are round, well circumscribed, measuring about 1-25 cm in diameter.

-  The cut surface shows characteristic honeycombed appearance.

-  Numerous small cysts are arranged around a central stellate scar which may be calcified.

- It occurs predominantly in women (median age 66 years).

2) Serous oligocystic (macrocystic) adenoma:

- These are often poorly demarcated and composed of larger cysts (1-2 cm in diameter).

- It occurs equally in both sexes and seems to occur as a part of von Hippel - Lindau syndrome.

- Microscopic features: 

Both types of cysts are lined by flattened or cuboidal cells with vacuolated cytoplasm (glycogen filled).

Nuclei are round and regular.

Micropapillae lined by cytologically bland epithelium are common.

Cysts are separated by vascularized and hyalinized fibrous tissue, which contain entrapped islets.

- Immunohistochemical findings:

-The tumours stain positively for cytokeratins and EMA, but not for CEA or, endocrine markers.

Serous oligocystic and ill-demarcated adenoma of the pancreas: a variant of serous cystic adenoma.

Serous oligocystic adenoma of the pancreas: a clinicopathological and immunohistochemical study of three cases with ultrastructural findings.

Pancreatic serous oligocystic adenomas: clinicopathologic features and a comparison with serous microcystic adenomas and mucinous cystic neoplasms.

3) von Hippel-Lindau-associated serous cystic neoplasm

4) Solid serous adenoma: Non-cystic variant of serous cystadenoma.

Solid serous adenoma of the pancreas: a rare variant within the family of pancreatic serous cystic neoplasms.

Solid serous adenoma of the pancreas: an uncommon but important entity.

Solid serous adenoma of the pancreas. The solid variant of serous cystadenoma?

5) Serous cystadenocarcinoma:  Extremely rare tumour.

The tumour shows invasive and metastatic growth.

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

Malignant serous cystic neoplasm of the pancreas: report of a case and review of the literature.

Risk of malignancy in serous cystic neoplasms of the pancreas.

Macrocystic serous cystadenocarcinoma of the pancreas: the first report of a new pattern of pancreatic carcinoma.



Further reading:

Pancreatic cystic neoplasms.

Solid serous microcystic adenoma of the pancreas.

Serous cystic neoplasms of the whole pancreas in a patient with von Hippel-Lindau disease.

Pancreatic manifestations of von Hippel-Lindau disease-effect of imaging on clinical management.

Differential diagnosis of pancreatic serous oligocystic adenoma and mucinous cystic neoplasm with spectral CT imaging: initial results.

Morphological analysis and differentiation of benign cystic neoplasms of the pancreas using computed tomography and magnetic resonance imaging.

Growth pattern of serous cystic neoplasms of the pancreas: observational study with long-term magnetic resonance surveillance and recommendations for treatment.

[Morphology of pancreatic serous cystadenomas].

[Microcystic serous pancreatic cystadenoma].

Management of 100 consecutive cases of pancreatic serous cystadenoma: wait for symptoms and see at imaging or vice versa?

The value of standard serum tumor markers in differentiating mucinous from serous cystic tumors of the pancreas: CEA, Ca 19-9, Ca 125, Ca 15-3.

Serous cystic neoplasms of the pancreas: an immunohistochemical analysis revealing alpha-inhibin, neuron-specific enolase, and MUC6 as new markers.

Serous neoplasms of the pancreas constitute a continuous spectrum of morphological patterns rather than distinct clinico-pathological variants. A study of 40 cases.

Multifocal serous cystadenoma of the pancreas synchronous with ampullary adenocarcinoma .

Multifocal pancreatic serous cystadenoma with atypical cells and focal perineural invasion.

Serous cystadenoma of the pancreas with papillary features: a diagnostic pitfall on fine-needle aspiration biopsy.

Multifocal serous cystadenoma of the pancreas synchronous with ampullary adenocarcinoma .

Macrocystic serous cystadenoma of the pancreas masquerading as a mucinous cystadenoma: case report.




Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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