Serous Cystic Tumors

In general, 10-15% of pancreatic cysts are considered to be primary cystic neoplasms. Cystic pancreatic neoplasms comprise only 1% of all pancreatic neoplasms and fall into two groups [1]. One group includes serous cystic tumors (SCTs), the other mucinous cystic tumors (MCTs). In 1978, Compagno and Oertel were the first to differentiate pathologically between SCTs and MCTs [2]. Recent molecular studies have revealed that SCTs can be distinguished from MCTs [3]. Accurate diagnosis of these neoplasms is important due to their varied clinical course and behavior. MCTs either carry a potential for malignant transformation or have already transformed into cystadenocarci-nomas at the time of presentation [4]. In contrast to MCTs, SCTs are generally believed to be benign [2, 5]. The cellular origin of SCTs has not yet been established. There is no uniform consensus on whether they originate from acinar, centroacinar, or ductal cells. However, the immunohistochemical and ultrastructural features of SCTs suggest a centroacinar cell origin [6-9].

SCTs of the pancreas are uncommon tumors and are usually classified as microcystic adenomas [2, 10]. The serous microcystic adenoma has a characteristic spongy gross appearance as a result of numerous tiny cysts and a central scar [1, 2, 5, 10]. The epithelial cells are rich in glycogen, giving rise to the alternative name of glycogen-rich cystadenoma [2]. In recent years, lesions of the pancreas, including SCTs, have been detected more easily because of the advance in diagnostic imaging methods. Moreover the morphologic spectrum and biologic diversity of SCTs have expanded. Two newly described SCTs, known as serous oligocystic adenoma and solid serous adenoma, have been reported as variants of the more familiar serous microcystic adenoma [1, 8, 11, 12]. SCTs are frequently incidental findings. It is important to distinguish between these subtypes. Due to slow growth, most SCTs do not require resection unless the patient is symptomatic [13, 14]. Malignant transformation of SCTs is exceedingly unusual. However, there have been several reports of malignant SCTs called serous cystadenocarcinoma [15-18].

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