A 68-year-old woman has an incidentally detected 4 cm pancreatic body lesion. CT shows a cluster of tiny cysts separated by thin septa giving a honeycomb pattern, with a central stellate scar containing sunburst calcification. There is no ductal dilatation and CA 19-9 is normal. The most appropriate next step is:
- A Distal pancreatectomy with splenectomy
- B Endoscopic ultrasound-guided cyst fluid aspiration for CEA
- C Neoadjuvant gemcitabine-based chemotherapy
- D Observation with periodic imaging ✓
Explanation
The honeycomb microcystic architecture with a central stellate scar bearing sunburst calcification is classic for serous cystadenoma, a benign tumor with essentially no malignant potential. Management in an asymptomatic patient is surveillance imaging. This distinguishes it decisively from mucinous cystic neoplasm, which occurs in middle-aged women in the body and tail, shows peripheral eggshell calcification, contains ovarian-type stroma, and does warrant resection. Aspiration for CEA is used to separate mucinous from non-mucinous lesions when imaging is equivocal, which is unnecessary with this characteristic picture.
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.