A 62-year-old woman is found incidentally to have a 5 cm pancreatic head lesion. CT shows a cluster of small cysts giving a honeycomb appearance with a central stellate scar containing stippled calcification. EUS-guided aspirate shows clear fluid with low CEA and low amylase. Cytology shows cuboidal cells rich in glycogen. What is the expected biological behavior?

• A High rate of progression to invasive carcinoma, mandating Whipple procedure
• B Nearly always benign, warranting observation unless symptomatic ✓
• C Benign initially but 30% malignant transformation over 10 years
• D Locally aggressive with perineural invasion but low metastatic potential

Explanation

Serous cystadenoma of the pancreas occurs in elderly women, shows a microcystic honeycomb pattern with central sunburst calcification, and is composed of glycogen-rich cuboidal cells with low CEA fluid. It is almost invariably benign, so asymptomatic lesions are observed; surgery is reserved for pain or biliary compression. This behavior contrasts sharply with mucinous cystic neoplasm and main-duct IPMN, which carry significant malignant potential and are resected.

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.