A 62-year-old woman undergoes workup for nonspecific abdominal pain. CT shows a 5 cm pancreatic body lesion made of numerous small cysts less than 2 cm each arranged around a central stellate scar with central calcification. No communication with the pancreatic duct is seen. EUS-guided aspirate shows cuboidal cells rich in glycogen with clear cytoplasm and low CEA. The appropriate management is:

• A Total pancreatectomy
• B Endoscopic cystogastrostomy drainage
• C Whipple procedure with regional lymphadenectomy
• D Surveillance, because the lesion is almost always benign ✓

Explanation

The features describe serous cystadenoma of the pancreas: a microcystic lesion with central stellate scar and calcification, composed of glycogen-rich cuboidal cells that stain with PAS, communicating with no duct, and secreting fluid with very low CEA. It occurs in elderly women and is almost uniformly benign, so surveillance alone is appropriate. Mucinous cystic neoplasm and IPMN carry malignant potential and would warrant resection, but their imaging and fluid profile differ.

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.