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  • Surgical Pathology Criteria
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    Serous Microcystic Adenoma of the Pancreas

    Definition

    • Benign pancreatic neoplasm composed of innumerable small cysts lined by bland clear cells

    cogen rich cystadenoma

    • Microcystic serous cystadenoma
    • Serous cystadenoma

    Covered separately

    Diagnostic Criteria

    • Solitary, circumscribed lesion
    • Innumerable small cysts
      • Most 1-5 mm
        • Scattered larger cysts
      • Sponge-like / honeycomb appearance
    • Lined by single layer of flattened or cuboidal cells with clear cytoplasm
      • Abundant glycogen (PAS +, diastase digestible)
      • Rarely eosinophilic cytoplasm
      • Sharp cell borders
      • Occasional intracystic papillary projections
    • Bland cytology
      • Small round/oval nuclei
      • No mitotic figures
    • Central stellate scar frequently present
      • May calcify
      • Scant stroma otherwise
      • Occasionally entraps other elements
    • Rarely may undergo cystic degeneration, mimicing pseudocyst (Panarelli)
    • Very rare cases that present with local invasion or lymph node metastases are considered serous cystadenocarcinoma

    Robert V Rouse MD
    Department of Pathology
    Stanford University School of Medicine
    Stanford CA 94305-5342

    Original posting / last update: 1/4/07, 6/17/12

    Supplemental studies

    Histochemistry

    Lining cells
    PAS+, diastase sensitive pos
    Mucin neg

    Immunohistology

    Lining cells

    CK7 pos
    CD8 pos
    CK18 pos
    CK19 pos
    MUC6 pos
    Neuron specific enolase pos
    Alpha inhibin 75%
    34BE12 / CK5 50%
    Chromogranin neg
    Synaptophysin neg
    Estrogen receptor neg
    Progesterone receptor neg
    Alpha 1 antitrypsin neg
    CK20 neg
    Smooth muscle actin neg
    CEA neg
    No stromal staining with any of the above markers

     

    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

    Clinical

    Grading / Staging / Report

    • Grading
      • Not applicable
    • Staging
      • Not applicable
    • Report
      • Comment that the lesion is benign

    Lists

    Cystic Pancreatic Lesions

    Bibliography

    • Solcia E, Capella C, Kloppel G . Tumors of the Pancreas, Atlas of Tumor Pathology, AFIP Third Series, Fascicle 20, 1997.
    • Bosman FT, Carneiro F, Hruban RH, Thiese ND (Eds). WHO Classifiication of Tumors of the Digestive System, IARC, Lyon 2010.
    • Kosmahl M, Wagner J, Peters K, Sipos B, Kloppel G. Serous cystic neoplasms of the pancreas: an immunohistochemical analysis revealing alpha-inhibin, neuron-specific enolase, and MUC6 as new markers. Am J Surg Pathol. 2004 Mar;28(3):339-46.
    • Yasuhara Y, Sakaida N, Uemura Y, Senzaki H, Shikata N, Tsubura A. Serous microcystic adenoma (glycogen-rich cystadenoma) of the pancreas: study of 11 cases showing clinicopathological and immunohistochemical correlations. Pathol Int. 2002 Apr;52(4):307-12.
    • Compagno J, Oertel JE. Microcystic adenomas of the pancreas (glycogen-rich cystadenomas): a clinicopathologic study of 34 cases. Am J Clin Pathol. 1978 Mar;69(3):289-98.
    • Basturk O, Coban I, Adsay NV. Pancreatic cysts: pathologic classification, differential diagnosis, and clinical implications. Arch Pathol Lab Med. 2009 Mar;133(3):423-38.
    • Panarelli NC, Park KJ, Hruban RH, Klimstra DS. Microcystic serous cystadenoma of the pancreas with subtotal cystic degeneration: another neoplastic mimic of pancreatic pseudocyst. Am J Surg Pathol. 2012 May;36(5):726-31
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