Surgical Pathology Criteria

Serous Oligocystic Adenoma of the Pancreas

Differential Diagnosis

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 Macrocystic / Oligocystic Adenoma Serous Cystadenocarcinoma of the Pancreas
Mass limited to pancreas, without vascular invasion Requires vascular invasion, adjacent organ invasion or metastases

Serous Macrocystic / Oligocystic 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

Serous Macrocystic / Oligocystic 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
Glycogen positive Glycogen negative
Keratin positive Keratin variable
Clear cell variant of solid pseudopapillary neoplasm is also reported to be glycogen negative

Serous Macrocystic / Oligocystic Adenoma Acinar Cell Cystadenocarcinoma of the Pancreas
Lined by clear cells Lined by cells with granular eosinophilic cytoplasm
PAS+, diastase sensitive PAS+, diastase resistant
BCL10, trypsin, chymotrypsin negative BCL10, trypsin, chymotrypsin positive

Serous Macrocystic / Oligocystic Adenoma Well Differentiated Pancreatic Neuroendocrine (Islet Cell) Tumor
Synaptophysin and chromogranin negative Synaptophysin and chromogranin positive
Islet cell tumors may occasionally have clear cytoplasm

Serous Macrocystic / Oligocystic Adenoma Lymphangioma
Lined by clear cells Lined by endothelium
Keratin positive CD31, CD34, D240 positive

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

Serous Macrocystic / Oligocystic Adenoma Squamoid Cyst of Pancreatic Ducts
Lined by clear cells Lined by squamoid cells
GLUT1 positive GLUT1 at most focally positive

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

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