Surgical Pathology Criteria

Serous Microcystic Adenoma of the Pancreas

Differential Diagnosis

Serous Microcystic Adenoma Mucinous Cystic Neoplasm of the Pancreas
Cuboidal clear epithelial lining Mucinous lining
Occurs in males and females Nearly all female
Lack ovarian type stroma Ovarian type stroma
Many small cysts Oligocystic or unilocular
Usually stellate central scar Lacks central scar
Glycogen positive, mucin negative Glycogen negative, mucin positive

Serous Macrocystic / Oligocystic Adenoma Serous Microcystic Adenoma
Small number of larger, variably sized cysts Innumerable small, uniform cysts
Lacks prominent scar Frequent central scar
May occur in adults and infants Not reported in infants

Serous Microcystic Adenoma Serous Cystadenocarcinoma of the Pancreas
Circumscribed intrapancreatic mass Requires vascular invasion, adjacent organ invasion or metastases
  • Serous adenoma and cystadenocarcinoma are histologically indistinguishable
  • Rare cases have been reported of resected non-invasive serous cystadenomas that recurred later with metastases
  • Serous Microcystic Adenoma Solid Pseudopapillary Neoplasm of the Pancreas
    True cysts lined by a single layer of cells Variable thickness of lining of degenerate spaces
    Occurs in males and females Nearly all female
    Median age 60's Mean age 20's
    Glycogen positive Glycogen negative
    Keratin positive Keratin variable
    Clear cell variant of solid pseudopapillary neoplasm is also reported to be glycogen negative

    Serous Microcystic Adenoma Acinar Cell Cystadenocarcinoma of the Pancreas
    Lined by clear cells Lined by cells with granular eosinophilic cytoplasm
    Frequent central scar Lacks central scar
    PAS+, diastase sensitive PAS+, diastase resistant
    BCL10, trypsin, chymotrypsin negative BCL10, trypsin, chymotrypsin positive

    Serous Microcystic Adenoma Lymphangioma
    Lined by clear cells Lined by endothelium
    Keratin positive CD31, CD34, D240 positive

    Serous Microcystic Adenoma Lymphoepithelial Cyst of the Pancreas
    Lined by clear cells Lined by squamous epithelium
    Lacks lymphoid stroma Prominent lymphoid stroma


    von Hippel Lindau syndrome is associated with diffuse cystic transformation of the pancreas and occasionally with serous microcystic adenomas

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