Serous cystadenoma of the pancreas (Microcystic adenoma): Case report

Yıl 2006, Cilt: 5 Sayı: 2, 130 - 133, 01.08.2006

Banu Doğan Gün Burak Bahadır Neslihan Kökten Bülent Hamdi Uçan Şükrü Oğuz Özdamar

Öz

Serous cystadenoma is a rarely seen benign cystic lesion of the pancreas. These lesions manifest with the symptoms of abdominal mass and gastrointestinal and bile duct obstruction, or may be seen incidentally. Herein we report an 82-year-old woman presenting with epigastric pain, nausea and vomiting with a pre-diagnosis of cholelithiasis. Whipple operation had been performed due to a nodularity seen at the head of the pancreas. The operation specimen revealed a well circumscribed mass with multiple tiny cysts giving the tumor a honeycomb appearance; multiple cysts lined by small, cuboidal cells having centrally located nucleus with clear cytoplasm were seen microscopically. There seemed to be no signs of anaplasia and the lesion was mitotically inactive. Histochemically positive staining was revealed in the cell cytoplasms with periodic acid-Schiff. Immunohistochemically with epithelial membrane antigen, staining was seen at the luminal surfaces of the cells, and with low molecular weight keratin, positive reaction was seen in the cytoplasms of the tumor cells. The lesion was thus diagnosed as serous cystadenoma based on these findings. Despite its rarity, serous cystadenoma should be kept in mind in the differential diagnosis of the cystic tumors as well as other non-neoplastic cysts of the pancreas.

Anahtar Kelimeler

Pancreas, cyst, serous cystadenoma, microcystic adenoma

Pankreasın seröz kistadenomu (Mikrokistik adenom): Olgu sunumu

Öz

Seröz kistadenom pankreasın nadir gözlenen benign kistik bir lezyonudur. Bu lezyonlar, abdominal kitle, gastrointestinal sistem ya da safra yolları obstrüksiyonu şeklinde bulgu verebilecekleri gibi, insidental olarak da gözlenebilirler. Bu makalede epigastrik ağrı, bulantı, kusma şikayetleri ile başvuran, koledokolithiazis ön tanısı ile ameliyata alınan 82 yaşında kadın hasta sunulmuştur. Olgunun operasyon sırasında pankreas başı bölgesinde nodülarite saptanması üzerine Whipple operasyonu yapı lmıştır. Spesimen üzerinde, pankreas başında bal-pateği görünümde alan izlenmiş olup; mikroskopik olarak küçük, yuvarlak santral yerleşimli nükleuslara sahip, şeffaf sitoplazmalı küboidal hücrelerin döşediği çok sayıda kist yapıları gözlendi. Patern olarak anaplazi kriterleri izlenmedi ve mitoz yönünden inaktif idi. Histokimyasal olarak "Periodic acid-Shiff" ile hücre sitoplazmalarında, immünohistokimyasal olarak ise "Epithelial Membrane Antigen" ile lüminal yüzde, düşük molekül ağırlı klı keratin ile tümör hücre sitoplazmalarında reaksiyon izlendi. Bu bulgularla olgu seröz kistadenom olarak rapor edildi. Seröz kistadenom, pankreasın az gözlenen kistik bir neoplazmı olmasına rağmen, ayırıcı tanı da pankreasın diğer kistik tümörleri ve yanı sıra neoplastik olmayan kistleri de akılda tutulmalıdır.

Anahtar Kelimeler

Pankreas, kist, seröz kistadenom, mikrokistik adenom

Kaynakça

• AS Koksal, M Asil, N Turhan ve ark. Serous microcystic adenoma of the pancreas: Case report and review of the literature. Turk J Gastroenterol 2004; 15: 183-6.
• Hruban RH, Wilentz RE. Non-neoplastic cysts and neoplasms of pancreas. In: Cotran RS, Kumar V, Robbins SL, Editors. Pathologic basis of disease. 7th ed. Philadelphia. WB Saunders 2005; 946-8.
• Rosai J. Rosai and Ackerman’s Surgical Pathology, 9th ed. Philadelphia. Mosby 2004; 1075-6.
• SY Baek, BC Kang, HY Choi, et al. Pancreatic serous cystadenoma associated with islet cell tumour. British J Radiol 2000; 73: 83-6.
• M Kosmahl, U Pauser, K Peters, et al. Cystic neoplasms of the pancreas and tumor-like lesions with cystic features: a review of 418 cases and a classification proposal. Virchows Arch 2004; 445: 168-78.
• C Lundstedt, S Dawiskiba. Serous and mucinous cystadenoma/cystadenocarcinoma of the pancreas. Abdomin Imag 2000; 5: 201-6.
• I Sluvkin, GR Hafez, JE Niederhuber et al. Combined serous microcystic adenoma and well-differentiated endocrine pancreatic neoplasm. Arch Pathol Lab Med 2003; 127: 1369-72.
• MO Ustun, N Tugyan, M Tunakan. Coexistence of an endocrine tumour in a serous cystadenoma (microcystic adenoma) of the pancreas, an unusual association. J Clin Pathol 2000; 53: 800-2.
• T Masatsugu, K Yamaguchi, K Chijiiwa, et al. Serous cystadenoma of the pancreas associated with pancreas divisum. J Gastoenterol n2002; 37: 669-73.
• JF Tseng, AL Warshaw, S Dushyant, et al. Serous cystadenoma ofthe pancreas: Tumor growth rates and reccommendations for treatment. Ann Surg 2005; 242: 413-21.