Coexisting pancreatic serous cystadenoma and pancreatic ductal adenocarcinoma: A cytological-pathologic correlation with literature review

Pancreatic serous cystadenoma (SCA) is a benign neoplastic lesion with a distinctive gross and microscopic appearance consisting of numerous thin-walled cysts lined by uniform epithelial cells with clear cytoplasm and small nuclei. The vast majority of serous cystadenomas are benign. Pancreatic SCA...

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Bibliographic Details
Published in:Annals of diagnostic pathology 2019-10, Vol.42, p.87-91
Main Authors: Rowan, Daniel, Pant, Mamta, Hagen, Catherine, Giorgadze, Tamara
Format: Article
Language:English
Subjects:
Aged
Carcinoma, Pancreatic Ductal - pathology
Cystadenoma, Serous - pathology
Fine needle aspiration
Humans
Male
Neoplasms, Multiple Primary - pathology
Pancreas
Pancreatic ductal adenocarcinoma
Pancreatic intraepithelial neoplasia
Pancreatic Neoplasms
Pancreatic Neoplasms - pathology
Serous cystadenoma
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Summary:Pancreatic serous cystadenoma (SCA) is a benign neoplastic lesion with a distinctive gross and microscopic appearance consisting of numerous thin-walled cysts lined by uniform epithelial cells with clear cytoplasm and small nuclei. The vast majority of serous cystadenomas are benign. Pancreatic SCA has rarely been reported in association with other pancreatic lesions. We present a challenging case in which a cystic and solid pancreatic mass was identified on imaging studies. FNA was performed and showed clusters of atypical cells with significant nuclear pleomorphism (>4:1), disorganized, overlapping nuclei, and prominent nucleoli. The FNA diagnosis was positive for malignancy, consistent with adenocarcinoma. The patient underwent neoadjuvant therapy and pancreaticoduodenectomy. Final pathology showed a serous cystadenoma associated with small foci of high-grade PanIN. The lack of invasive adenocarcinoma in the resection specimen was most likely due to complete response of the tumor to neoadjuvant chemoradiation therapy, but it is also possible that only high-grade PanIN was present initially. To our knowledge, this is the first reported case of SCA and high grade PanIN/PDAC that was assessed by FNA. We discuss the cytologic differential diagnosis and how to avoid potential pitfalls highlighted by this case. •This is a rare case of coexisting pancreatic serous cystadenoma and pancreatic ductal adenocarcinoma that was initially sampled by FNA.
ISSN:1092-9134
1532-8198
DOI:10.1016/j.anndiagpath.2019.07.006