A 62-year-old woman has an incidentally detected 5 cm pancreatic head lesion. CT shows a microcystic honeycomb appearance with a central stellate calcification. EUS-guided biopsy shows cuboidal cells with clear, glycogen-rich cytoplasm lining small cysts. Cyst fluid analysis shows low CEA and low amylase. The correct statement about this lesion is:

• A It is associated with von Hippel-Lindau disease and is almost always benign ✓
• B It frequently harbors KRAS mutations and requires surgical resection
• C It carries the highest malignant potential among pancreatic cystic neoplasms
• D It occurs almost exclusively in women and contains ovarian-type stroma

Explanation

Serous cystadenoma is a benign microcystic ('honeycomb') neoplasm composed of glycogen-rich cuboidal cells with clear cytoplasm, classically showing a central stellate scar with calcification. It is associated with von Hippel-Lindau disease, in which VHL gene loss drives multiple serous cystadenomas and renal cell carcinomas. Cyst fluid characteristically shows low CEA and low amylase. Mucinous cystic neoplasm, not serous cystadenoma, is the female-predominant lesion with ovarian-type stroma, and IPMN and mucinous cystic neoplasm carry significant malignant potential requiring closer surveillance or resection.

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.