Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA.
Am J Surg Pathol. 2012 May;36(5):726-31. doi: 10.1097/PAS.0b013e31824cf879.
Pancreatic serous cystadenomas are benign cystic neoplasms. Extensive degeneration mimicking a pancreatic pseudocyst has been described in several types of pancreatic neoplasms but has not been documented in serous cystadenomas. We report subtotal cystic degeneration of microcystic serous cystadenomas (MSCA) that produces radiographic, gross, and microscopic overlap with pancreatic pseudocyst.
Resected MSCA with degenerative change were identified from the pathology archives of Memorial Sloan-Kettering Cancer Center and Johns Hopkins Hospital. The clinical, radiographic, gross, and microscopic findings were reviewed.
Eight MSCAs with subtotal cystic degeneration were retrieved from among 397 resected serous cystadenomas (2.0%). There were 2 men and 6 women (mean age, 52 y). Available radiographic studies showed classic features of MSCA in 2 of 4 cases. Four cysts were unilocular, and 4 were multilocular. Gross features of MSCA were noted focally in the multilocular cases but were not evident in the unilocular examples. The predominant histologic features were those of pancreatic pseudocyst, including a fibrotic cyst wall lacking epithelium and instead composed of myofibroblastic proliferation, hemorrhage, and inflammation. Residual foci of MSCA were embedded in fibrosis, comprising 5% to 60% of the tumor volume.
Most pancreatic serous cystadenomas display characteristic morphology, including a glycogen-rich epithelial lining and prominent subepithelial capillaries; however, extensive degenerative macrocystic change can obscure these classic features. This phenomenon is to be distinguished from macrocystic serous cystadenoma, in which thin-walled macrocystic spaces are epithelium lined. Thus, serous cystadenoma should be included in the differential diagnosis of pancreatic masses with extensive degenerative cystic change.
胰腺浆液性囊腺瘤是良性囊性肿瘤。几种胰腺肿瘤已描述了广泛的退行性变，类似于胰腺假性囊肿，但在浆液性囊腺瘤中尚未记录。我们报告了微囊型浆液性囊腺瘤（MSCA）的部分囊性退行性变，其产生的影像学、大体和显微镜下表现与胰腺假性囊肿重叠。
从纪念斯隆-凯特琳癌症中心和约翰霍普金斯医院的病理档案中确定了具有退行性改变的 MSCA。回顾了临床、影像学、大体和显微镜下的发现。
从 397 例切除的浆液性囊腺瘤中获得了 8 例具有部分囊性退行性变的 MSCA（2.0%）。有 2 名男性和 6 名女性（平均年龄，52 岁）。4 例中有 2 例有可用的影像学研究显示 MSCA 的典型特征。4 个囊肿为单房性，4 个为多房性。在多房性病例中观察到 MSCA 的大体特征，但在单房性病例中不明显。主要的组织学特征是胰腺假性囊肿，包括缺乏上皮的纤维化囊壁，而由肌纤维母细胞增生、出血和炎症组成。MSCA 的残留灶嵌入纤维化中，占肿瘤体积的 5%至 60%。
大多数胰腺浆液性囊腺瘤表现出特征性形态，包括富含糖原的上皮衬里和突出的上皮下毛细血管；然而，广泛的退行性大囊变可能会掩盖这些典型特征。这种现象与大囊型浆液性囊腺瘤不同，后者的薄壁大囊腔衬有上皮。因此，浆液性囊腺瘤应包括在具有广泛退行性囊性改变的胰腺肿块的鉴别诊断中。
