Serous Cystic Neoplasms of the Pancreas

Cystic pancreatic masses are frequently identified on abdominal cross-sectional imaging and pose a diagnostic challenge for the clinical care team. Given the incidence and aggressiveness of pancreatic cancer, it is incumbent upon the care team to determine an accurate diagnosis of all solid and cystic masses of the pancreas. Pancreatic serous cystic neoplasms (SCN), also referred to as serous cystadenoma, compose about 30% of pancreatic cystic neoplasms and, unlike other pancreatic cysts, are usually benign (see Serous Cystadenoma in Computed Tomography).  More commonly, clinicians' attention is focused on mucinous cystic neoplasms (MCN) and intraductal papillary mucinous neoplasms (IPMN), which have a substantial malignant predisposition. Hence, an accurate diagnosis of SCNs usually avoids the need for surgery and its associated morbidity, expense, and inconvenience. With increased use and advances in abdominal cross-sectional imaging, the detection of pancreatic cystic lesions has increased, particularly in asymptomatic individuals. Differentiation and accurate diagnosis are therefore critical, as prognoses and management vary. The most common cystic lesion of the pancreas is the pseudocyst, which typically develops following episodes of acute pancreatitis. Pseudocysts lack an epithelial lining and are therefore considered "false" cysts. In contrast, "true" cysts possess an epithelial lining, making them susceptible to malignant transformation. Additional types of pancreatic cystic masses include MCN, IPMN, cystic neuroendocrine neoplasm, solid-pseudopapillary neoplasm (also referred to as Hamoudi tumor), acinar-cell cystic neoplasm, and ductal adenocarcinoma with cystic degeneration. This review examines the pathophysiology, clinical presentation, diagnosis, and treatment of SCNs.