Diagnostic and Interventional Imaging (2017) 98, 191—202

PICTORIAL REVIEW /Abdominal imaging

The many faces of pancreatic serous

cystadenoma: Radiologic and pathologic
correlation夽
L.C. Chu a,∗, A.D. Singhi b, R.R. Haroun a,
R.H. Hruban c, E.K. Fishman a

a
The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins
Hospital, 600 North Wolfe Street, Halsted B168, 21287 Baltimore, MD, USA
b
Department of Pathology, University of Pittsburgh Medical Center, 15213 Pittsburgh, PA, USA
c
The Sol Goldman Pancreatic Cancer Research Center, The Department of Pathology, Johns
Hopkins Hospital, 401 North Broadway, 21231 Baltimore, MD, USA

KEYWORDS Abstract Pancreatic serous cystadenoma can be categorized into microcystic, honeycomb,
Pancreas; oligocystic, and solid patterns based on imaging appearance. The presence of typical computed
Serous cystadenoma; tomography (CT) features helps to differentiate serous cystadenomas from other cystic and
Computed solid pancreatic masses. Cases with atypical features present a diagnostic challenge as they
tomography; can mimic malignant neoplasms. This article reviews pathophysiology, prevalence, CT features,
Pancreatic cysts mimickers and recommendations for management of pancreatic serous cystadenoma.
© 2016 Editions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

The prevalence of pancreatic cystic lesions on abdominal imaging has been reported to
be between 2.6% to 19.6% [1—3]. Pancreatic serous cystic neoplasms account for approx-
imately 16% of primary cystic pancreatic neoplasms. Although magnetic resonance (MR)
imaging is frequently used for characterization of cystic pancreatic lesions [4,5], com-
puted tomography (CT) remains the first line imaging modality due to more widespread
availability. Most serous cystic neoplasms are benign and represent pancreatic serous cys-
tadenomas (SCAs). Serous cystadenoma is a benign neoplasm composed of glycogen-rich
epithelial cells that form innumerable small thin-walled cysts containing serous fluid [6,7].

夽 The contents were previously presented as an Educational Exhibit in Radiological Society of North America meeting 2011 in Chicago, IL,

USA and as an Educational Exhibit in American Roentgen Ray Society meeting 2012 in Vancouver, BC, Canada.
∗ Corresponding author.

E-mail address: lindachu@jhmi.edu (L.C. Chu).

http://dx.doi.org/10.1016/j.diii.2016.08.005
2211-5684/© 2016 Editions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.
192
Microscopically, they appear as single layer of cuboidal
or flattened cells lining the small cysts and have round
nuclei and abundant clear cytoplasm. Features of atypia
or dysplasia are absent (Fig. 1) [7]. Endoscopic ultrasound
and fluid aspiration may be helpful in differentiating serous
cystadenoma from other pancreatic cystic lesions. The pres-
ence of mucin and carcinoembryonic antigen > 192 ng/mL
in the fluid aspirate have high specificity for discrim-
inating mucinous from nonmucinous lesions [8,9]. Fluid
aspirate amylase < 250 U/L excludes pancreatic pseudocysts
[8]. Cytologic evaluation after endoscopic ultrasound fine
needle aspiration can establish the diagnosis in about 50%
of patients, with pathognomonic findings of bland cuboidal
glycogen and staining cells [9].
Approximately 40% of pancreatic serous cystadenoma
arise from the pancreatic head and uncinate process and 60%
arise from the pancreatic body and tail [3]. These neoplasms
have a predilection for middle-aged and older women and
are usually discovered incidentally [3]. Up to 60% of patients
are asymptomatic. Alternatively, patients may present with
non-specific symptoms such as abdominal pain, abdominal
mass, and rarely jaundice [3].
Figure 1. Serous cystadenoma: a: gross pathology photograph shows spongiform appearance of the serous cystadenoma with numerous
microcysts; b: low power; c: high power histopathologic slides show numerous tightly packed small cysts (*) lined by cuboidal cells with
clear cytoplasm and small round uniform nuclei (arrow).
Table 1 Typical versus atypical features of pancreatic serous cystadenoma.
Typical features
Central scar ± calcifications
Lobulated external contour
No communication with pancreatic duct
Absence of aggressive features
L.C. Chu et al.
Classically, pancreatic serous cystadenomas have been
described as multilobulated multiloculated cystic masses
with central stellate scars and calcifications (Table 1). How-
ever, serous cystadenomas have a wide spectrum of CT
appearance, ranging from unilocular cystic masses to hyper-
vascular solid masses, which can mimic other benign and
malignant pancreatic masses. Serous cystadenomas can be
morphologically classified as polycystic (or microcystic),
honeycomb, oligocystic, and solid patterns [10].
In this article, we present the different CT appearances
of serous cystadenomas correlated with gross pathology
images to maximize the diagnostic certainty of this benign
entity and prevent unnecessary surgical interventions and
review current management recommendations.
Patterns of pancreatic serous cystadenoma
Microcystic pattern
The microcystic pattern, or polycystic pattern, is present in
1—2% of all exocrine pancreatic tumors and in 70% cases of
Atypical aggressive features
Pancreatic parenchymal atrophy
Dilatation of pancreatic duct and/or common bile duct
Vascular invasion
Invasion of adjacent structures
The many faces of pancreatic serous cystadenoma 193

serous cystadenomas, and consists of a collection of cysts
(usually more than 6) that range from a few millimeters up
to 2 cm in size. Fine external lobulations are a common and
characteristic feature. A fibrous central scar with or without
a stellate pattern of calcifications (Figs. 2—4), seen in 30% of
cases, is highly specific for serous cystadenoma. Serous cys-
tadenomas do not usually communicate with the pancreatic
duct (Fig. 5) [11].
Honeycomb pattern
The honeycomb pattern is seen in ∼20% of cases, and con-
sists of numerous tiny cysts that mimic a honeycomb or a
sponge. These tiny cysts may be poorly depicted as indi-
vidual cysts on CT. These serous cystadenomas appear as
soft tissue or mixed attenuation masses depending on the
size of the cysts and the amount of enhancing fibrous tissue
(Figs. 6 and 7) [10].
Oligocystic pattern
The oligocystic pattern also known as the macrocystic
pattern is seen in less than 10% of cases. It is composed
of fewer but larger (> 2 cm) cysts and lacks the central
stellate scar [7,12]. It may be difficult to differentiate
the oligocystic variant from mucinous cystic neoplasms
or side-branch intraductal papillary mucinous neoplasms
(IPMNs). The presence of external lobulations favors serous
cystadenoma over mucinous cystic neoplasms and IPMNs
[13] (Fig. 8). Dilatation of the pancreatic duct is an unusual
feature and may be seen in rare cases (Fig. 9) [14].
Solid pattern
Rare cases of solid variant of serous cystadenoma have
been described. These serous cystadenomas do not con-
tain any cystic spaces on histopathology and the cells are
arranged in nests, sheets, and trabeculae separated by
thick fibrous bands. The stroma demonstrates avid con-
trast enhancement and accounts for the solid hypervascular
appearance on CT (Fig. 10). In other cases, the serous cys-
tadenoma is not completely solid, but contains prominent
stromal hyalinization with relatively few cystic compo-
nents, which also imparts a solid hypervascular configuration
on CT (Figs. 11 and 12). Serous cystadenomas may also
demonstrate intratumoral hemorrhage (Fig. 12), which also
contributes to the high density solid appearance of these
lesions. This pattern could be easily misdiagnosed as neu-
roendocrine tumor of the pancreas, or other solid pancreatic
neoplasms [15].

Figure 2. A 77-year-old female with a microcystic serous cystadenoma: a: axial IV contrast enhanced CT; b: gross pathology photograph
show a microcystic mass within head of pancreas with fine external lobulations and mutiple thin enhancing internal septations. Fibrous
central scar with calcification (arrow) is a classic feature of serous cystadenoma.

Figure 3. A 74-year-old male with a microcystic serous cystadenoma: a: axial IV contrast enhanced CT; b: gross pathology photograph show
a microcystic mass within tail of pancreas with characteristic central stellate scar with calcifications (arrow) and thin internal enhancing
septations (arrowhead).
194 L.C. Chu et al.

Figure 4. A 73-year-old male with a microcystic serous cystadenoma: a: axial IV contrast enhanced CT; b: gross pathology photograph
show a microcystic mass in the tail of pancreas with characteristic fibrous central scar and calcifications (arrows) and thin enhancing internal
septations (arrowhead).

Figure 5. A 68-year-old female with a microcystic serous cystadenoma: a: axial IV contrast enhanced CT shows a polycystic mass within
body of pancreas with the characteristic lobulated margin (arrowheads); b: gross pathology photograph shows no communication between
the cystic mass and the main pancreatic duct (arrowheads) despite their physical proximity.

Figure 6. A 46-year-old female with a honeycomb serous cystadenoma within body of pancreas: a: axial IV contrast enhanced CT shows
lobulated spongiform mass (arrow) with poor visualization of individual microcysts; b: gross pathology photograph illustrate numerous
microcysts in the honeycomb pattern.

Aggressive behavior of atypical serous
cystadenomas
Rare cases of locally aggressive serous cystadenomas have
been described, manifesting as tumors with direct invasion
into large blood vessels, nerves, lymph nodes and nearby
structures (Fig. 13). These aggressive lesions do not exhibit
cytological or architectural atypia, and are histologically
similar to typical serous cystadenomas. Large tumor size
and location within the head of the pancreas are associ-
ated with aggressive behavior, and should be considered in
the management of patients with serous cystadenomas [16].
Table 1 summarizes the features of typical versus aggressive
pancreatic serous cystadenoma.
The many faces of pancreatic serous cystadenoma 195

Figure 7. A 73-year- old female with a honeycomb serous cystadenoma within head of pancreas: a: axial IV contrast enhanced CT shows
lobulated spongiform mass with poor visualization of individual microcysts (arrow); b: gross pathology photograph illustrate honeycomb
pattern of microcysts and central fibrous scar (arrowhead).

Figure 8. A 18-year-old female with oligocystic serous cystadenoma: a: axial IV contrast enhanced CT shows a thin-walled cystic mass
within tail of pancreas with minimally lobulated outer margin (arrow); b: gross pathology photograph shows an oligocystic mass wrapping
around a mildly dilated pancreatic duct without direct communication with the pancreatic duct (arrowheads).

Cystic pancreatic lesions mimicking
pancreatic serous cystadenomas
As previously indicated, pancreatic serous cystadenoma
exhibit a wide spectrum of heterogeneous pattern on CT. For
example, the oligocystic pattern might be misinterpreted
as a mucinous cystadenoma or mucinous cystadenocarci-
noma, while the solid pattern might be misinterpreted as
a solid NET or adenocarcinoma [15]. Table 2 summarizes
the differential diagnosis of cystic lesions mimicking serous
cystadenoma. The demographic predilections and common
radiologic features of these cystic lesions are clarified in
Table 3.
Pseudocyst
Pseudocysts are the most common type of pancreatic cystic
lesion (30%) [7]. Pseudocysts frequently appear as uniloc-

Figure 9. A 48-year-old male with an oligocystic serous cystadenoma: a: axial IV contrast enhanced CT shows a thin-walled cystic mass
within head of pancreas (arrow) with atrophy of the body and tail with dilatation of the pancreatic duct (arrowheads); b: gross pathology
photograph shows an oligocystic mass (arrow) causing obstruction of a dilated pancreatic duct (arrowheads), an atypical feature for serous
cystadenoma. Case previously published in Chu et al., reproduced with permission [22].
196 L.C. Chu et al.

Figure 10. A 69-year old male with solid variant of serous cystadenoma: a: axial IV contrast enhanced CT shows a hypervascular mass
within tail of pancreas abutting the splenic hilum, with occlusion of the splenic vein (arrow); b: gross pathology photograph shows solid
mass within the pancreatic tail abutting the spleen (S); c and d: histopathology slides show solid sheets of tumor cells with absence of cystic
spaces and presence of perineural invasion (arrowheads), unusual features of SCA. Case previously published in Chu et al., reproduced with
permission [22].

ular cystic masses, but some pseudocysts may contain
multiple internal septations. On CT, pseudocysts appear
as round or oval fluid collection with thin enhancing
fibrous capsule, which may calcify. They contain fluid that
is less than 15 HU; higher fluid attenuation to 40—50
HU indicates intracystic hemorrhage [17]. Communica-
tion of the pseudocyst with the pancreatic duct may be
seen on MRCP. Imaging and laboratory findings of pan-
creatitis are the best diagnostic clue to the diagnosis of
pseudocyst (Fig. 14).
Mucinous cystic neoplasm
Mucinous cystic neoplasms may mimic the oligocystic vari-
ant of serous cystadenoma. Mucinous cystic neoplasms are
seen almost exclusively in perimenopausal female patients
(female:male > 20:1) and most arise in the body or tail of the
pancreas [7]. Smooth external contour is the key diagnostic
feature of mucinous cystic neoplasm [13]. The presence of
thick internal septations and mural nodules raises concern
for malignancy in mucinous cystic neoplasms (Fig. 15).

Figure 11. A 44-year-old female with a solid appearing serous cystadenoma: a: axial IV contrast enhanced CT shows hypervascular mass
with lobulated margins within head of pancreas (arrow); b: gross pathology photograph shows prominent hyalinized stroma which corresponds
to areas of avid contrast enhancement (arrow).
The many faces of pancreatic serous cystadenoma 197

Figure 12. A 70-year-old female with a solid appearing serous cystadenoma: a: axial IV contrast enhanced CT shows hypervascular mass
with lobulated margins within head of pancreas with areas of internal hemorrhage (arrows); b: gross pathology photograph shows prominent
stromal component and intramural hemorrhage (arrows), which account for its solid appearance on CT.

Intraductal papillary pancreatic neoplasms
(IPMN)
IPMNs account for approximately 20% of cystic pancreatic
lesions. They occur slightly more frequently in men than
in women. Seventy percent of IPMNs occur in the head of
the pancreas. IPMNs may involve primarily the main pancre-
atic duct (main duct type), or be confined to the branch
ducts (branch duct type) [7]. Key diagnostic features of
IPMNs include communication with pancreatic duct and a
pleomorphic or clubbed fingerlike cystic shape (Fig. 16) [13].
Cystic neuroendocrine tumor (NET)
Neuroendocrine tumors typically appear as hypervascular
masses on CT. However, 11% of NET appear cystic on imaging
and can mimic serous cystadenoma. Cystic NET represents
5.4% of all cystic pancreatic lesions. Peripheral rim hyper-
enhancement is a feature that has been described in 85%
of cystic pancreatic NETs (Fig. 17) [18], which is usually not
present in serous cystadenoma.
Disseminated variant
Von Hippel-Lindau disease is an autosomal dominant disease
with CNS and retinal hemangioblastomas, visceral cysts,
pheochromocytomas, and renal cell carcinomas. Up to 56%
of patients with von Hippel-Lindau disease have pancreatic
lesions, including cysts, serous cystadenomas, and neuroen-
docrine tumors (Fig. 18).

Figure 13. A 59-year-old man with aggressive serous cystadenoma: a: axial IV contrast enhanced CT shows a heterogeneous cystic and
solid mass within head of pancreas with encasement and compression of the portal vein (arrow); b: axial IV contrast enhanced CT shows
atrophy of the body and tail with dilatation of the pancreatic duct (arrow) and intrahepatic biliary dilatation (arrowhead) from mass effect;
c: histopathology slide shows extension of tumor (T) into a peripancreatic lymph node (LN).
198 L.C. Chu et al.

Table 2 Key distinguishing features of cystic pancreatic lesions mimicking pancreatic serous cystadenoma.
Cystic pancreatic mass Key distinguishing features
Pseudocyst Smooth external contour
Peripancreatic stranding
Clinical history of pancreatitis
Mucinous cystic neoplasm Smooth external contour
Relatively thick enhancing wall
Peripheral calcifications
Thick internal septations and nodularity suggestive of malignancy
IPMN Pleomorphic and tubular external contour
Communication with main pancreatic duct or side-branch
Thick internal septations and nodularity suggestive of malignancy
Cystic neuroendocrine tumor Presence of hypervascular halo
Presence of liver metastases
Clinical history of endocrinopathy (rare in cystic neuroendocrine)
25% association with MEN syndrome
Von Hippel-Lindau disease Multiple pancreatic lesions, including cysts, serous cystadenomas, and
neuroendocrine tumors
Other stigmata: renal cell carcinoma, pheochromocytoma, CNS and retinal
hemangioblastomas
Lymphoepithelial cyst Protrude into peripancreatic soft tissues

Lymphoepithelial cyst Solid pancreatic masses that mimic serous

Lymphoepithelial cysts have a male predominance
(male:female 4—7:1) with mean age of presentation
at 56 years. Lymphoepithelial cysts are unilocular (40%)
or multilocular (60%) cystic lesions lined with squamous
epithelium without atypia and surrounded by dense epithe-
lial lymphoid tissue and follicles accompanied by germinal
centers [19]. They can be seen in any component of the
pancreas and often project into the peripancreatic tissues.
On CT, they appear as well circumscribed low attenuation
masses with a thin enhancing rim, septations, and focal
calcifications. Intracystic contents usually measure 20—30
HU due to high levels of keratin (Fig. 19) [17].
cystadenomas
The most common features of pancreatic solid neoplasms
that could mimic pancreatic serous cystadenomas are sum-
marized in Table 4.
Pancreatic adenocarcinoma
Pancreatic adenocarcinoma usually presents as an ill-defined
hypoattenuating mass as opposed to a well-defined cystic
mass in cases of serous cystadenoma. Aggressive features
such as pancreatic and/or common bile duct dilatation,
pancreatic parenchymal atrophy, vascular invasion, liver

Table 3 Summary of demographic predilection of cystic pancreatic lesions and their common appearing features on CT.
Serous Mucinous IPMN Pseudocyst Cystic Lymphoepithelial
cystadenoma cystic neuroendocrine cyst
neoplasm tumor
Age range 60—80 30—50 60—80 30—70 20—90 60—80
M:F ratio 1:3—4 1:9 1—2:1 1:1 1:1 4:1
Location Body- Body- Head > body- Even Tail > head, body Even distribution
tail > Head tail > Head tail distribution
External margin Lobulated Smooth Tubular Smooth Smooth Smooth
Unilocular or Both Both Both Both Both Both
multilocular
Calcifications Central Scar Peripheral Peripheral Peripheral Absent Peripheral
Communication Absent Absent Present Present Absent Absent
with MPD
Malignant Extremely Yes Yes No Yes No
potential rare
Clinical history Pancreatitis
The many faces of pancreatic serous cystadenoma
Figure 14. A 63-year-old male with history of pancreatitis, axial
IV contrast enhanced CT shows a large cystic mass in the left upper
quadrant from a pseudocyst (arrow).
Figure 15. A 35-year-old female with mucinous cystadenocar-
cinoma, axial IV contrast enhanced CT shows a thick walled
multiseptated cystic mass in the pancreatic tail (arrow) with mul-
tiple thick enhancing septations (arrowhead).
Figure 16. A 78-year-old male with main duct IPMN, coronal IV
contrast enhanced CT shows marked cystic dilation of main pancre-
atic duct (arrows).
199
Figure 17. A 74-year-old female with cystic neuroendocrine
tumor (NET), axial IV contrast enhanced CT shows a cystic mass
with thick peripheral enhancing rim in the pancreatic tail (arrow)
a feature that helps differentiate pancreatic NET from serous cys-
tadenoma.
Figure 18. A 43-year-old female with von Hippel-Lindau (VHL)
disease, axial IV contrast enhanced CT shows innumerable cystic
masses throughout the pancreas. Key to the differential diagnosis
is association with renal cell carcinoma and hemangioblastoma (not
shown).
Figure 19. A 38-year-old male with lymphoepithelial cyst, coro-
nal IV contrast enhanced CT shows a multiloculated cystic masses
within the peripancreatic soft tissues projecting near the pancreatic
head (arrow).
200
Table 4 Key distinguishing features of solid pancreatic lesions mimicking solid variant of pancreatic serous cystadenoma.
Solid pancreatic mass
Adenocarcinoma
Neuroendocrine tumor
Solid pseudopapillary neoplasm
Metastasis (i.e. renal cell carcinoma)
metastases, and lymphadenopathy are not seen with serous
cystadenoma. The presence of any of these features is highly
worrisome for pancreatic adenocarcinoma (Fig. 20).
Pancreatic neuroendocrine tumor (PNET)
Pancreatic neuroendocrine tumor (PNET) typically presents
as a hypervascular mass that is best appreciated on the arte-
rial phase (Fig. 21). This tumor arises from pancreatic islet
cells and does not commonly compress the pancreatic duct
unless it reaches large mass size (> 3 cm). Functional tumors
are commonly diagnosed early (< 3 cm) due to secretion of
active hormones, while nonfunctional tumors are diagnosed
late and commonly associated with liver metastasis and lym-
phadenopathy. Clinical history of endocrinopathy, presence
of liver metastases and lymphadenopathy are helpful fea-
tures to distinguish PNET from serous cystadenoma.
Pancreatic solid pseudopapillary neoplasm
Solid pancreatic pseudopapillary tumor is a rare tumor that
has predilection to young women, especially from African
or Asian descendant. It presents with vague symptoms and
Figure 20. A 55-year-old female with pancreatic adenocarci-
noma, axial IV contrast enhanced CT shows ill-defined hypodense
mass in pancreatic head (arrow) causing biliary ductal dilatation
(arrowhead).
L.C. Chu et al.
Key distinguishing features
Ill-defined margins
Vascular invasion
Pancreatic duct dilatation and parenchymal atrophy
Common bile duct dilatation
Liver metastases and lymphadenopathy
Clinical history of endocrinopathy
Presence of liver metastases
Young women
Cystic solid mass with thick tumor capsule
Intratumoral hemorrhage
History of renal cell carcinoma
Presence of suspicious renal mass
might be found incidentally while imaging for other rea-
sons or when tumor mass enlarges enough to compress
adjacent structures. It is mostly benign but has malignant
potential that might present with liver metastases and lym-
phadenopathy. On CT, it appears as a well encapsulated mass
that consists of solid and cystic components resulting from
various degree of hemorrhagic necrosis (Fig. 22). Solid com-
ponent is usually peripheral while cystic component tend
to be central [20]. Patient demographic (young women vs.
middle-aged and older women) is useful in distinguishing
solid pseudopapillary tumor from serous cystadenoma.
Metastasis to pancreas
Metastases to pancreas are rare (less than 4% of pancreatic
masses). Most common tumors that metastasize to pan-
creas are renal cell carcinoma, sarcoma, melanoma, lung
cancer, colon cancer and breast cancer. They present usu-
ally in the initial years following diagnosis of the primary
cancer. Renal cell carcinoma metastases to pancreas, how-
ever, might present within up to 20 years following the
initial diagnosis. Metastatic renal cell carcinomas are typ-
ically hypervascular masses with multiple masses involving
Figure 21. A 55-year-old female with pancreatic neuroendocrine
tumor, axial IV contrast enhanced CT shows a large hypervascular
mass in pancreatic head (arrow) with pancreatic duct dilatation
(arrowhead).
The many faces of pancreatic serous cystadenoma
Figure 22. A 39-year-old female with solid pseudopapillary neo-
plasm, axial IV contrast enhanced CT shows a heterogeneous cystic
solid mass in pancreatic tail with areas of internal hemorrhage
(arrowhead).
Figure 23. A 59-year-old female with history of renal cell carci-
noma, axial IV contrast enhanced CT shows multiple hypervascular
masses in pancreas (arrows) from metastatic renal cell carcinoma.
the pancreas (Fig. 23). History of primary tumor is often
needed for considering pancreatic metastases in the differ-
ential diagnosis of an indeterminate pancreatic lesion.
Management
Management of serous cystadenomas depends on patients’
age and comorbidities, tumor size and location, presence or
absence of symptoms, local practice patterns, and surgeon
preferences. If the diagnosis of serous cystadenoma can be
made based on imaging and/or endoscopic ultrasound fine
needle aspiration, surgical resection is usually reserved for
symptomatic patients and patients with tumor > 4 cm in size
regardless of symptoms. Follow-up imaging every 2 years is
recommended for serous cystadenomas between 2 and 3 cm.
The growth patterns for serous cystadenomas were similar
regardless of initial size with estimated doubling time of
12 years. Doubling of size in less than 12 years should be
considered for resection regardless of initial reported size
[21].
201
However, not all cases of serous cystadenomas demon-
strate typical CT features and remain indeterminate. For
asymptomatic patients with pancreatic cystic lesions, the
American College of Radiology Incidental Committee guide-
lines recommend a single follow-up in 1 year for lesions
smaller than 2 cm, with no further follow-up if patient still
does not manifest any clinical symptoms [8].
Conclusion
Pancreatic serous cystadenoma are benign lesions that do
not commonly mandate surgical resection and could be
managed by surveillance unless they exhibit aggressive pat-
tern or unspecific features that prevent establishing certain
diagnosis. CT is the first line modality of choice for char-
acterization of serous cystadenoma and in differentiating it
from its mimickers.
Disclosure of interest
The authors declare that they have no competing interest.
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