A 58-year-old woman has an incidental 3 cm pancreatic body cyst. Endoscopic ultrasound shows a microcystic honeycomb appearance with a central stellate scar containing calcification. There is no communication with the main pancreatic duct. Cyst fluid shows CEA less than 5 ng/mL and amylase 40 U/L. Cytology shows cuboidal cells rich in glycogen. The most appropriate management is:

• A Distal pancreatectomy with splenectomy
• B Endoscopic ultrasound-guided ethanol ablation
• C Total pancreatectomy
• D Observation with surveillance imaging ✓

Explanation

The findings are classic for serous cystadenoma: a microcystic honeycomb lesion, central stellate calcified scar, glycogen-rich cuboidal epithelium, and low CEA. Serous cystadenomas are almost invariably benign even when large, so resection is unnecessary unless symptoms develop. The low CEA excludes a mucinous lesion, which is the main differential concern driving unnecessary surgery. Amylase is low because these cysts do not communicate with the duct system.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.