What is Pancreatic Serous Cystadenoma?
Pancreatic serous cystadenomas are mostly non-cancerous and are one of the most common types of primary cystic growths in the pancreas, accounting for one-third of such conditions. To put it simply, these are fluid-filled sacs that develop within the pancreas. Patients usually don’t experience any symptoms.
Other types of growths in the pancreas include mucinous cystic growths, intraductal papillary mucinous growths, cystic neuroendocrine growths, solid-pseudopapillary growths, acinar-cell cystic growths, and ductal adenocarcinoma with cystic degeneration. These all represent different forms and categories of growths that can occur in the pancreas.
With the advancement and increased use of detailed imaging scans of the abdomen, doctors have been able to detect these conditions better, particularly in patients who don’t have symptoms. This article will focus on discussing the cause, symptoms, diagnosis, and treatment options for pancreatic serous cystadenoma.
What Causes Pancreatic Serous Cystadenoma?
The exact cause of serous cystadenomas, a type of benign tumor that forms in the ovaries or pancreas, isn’t entirely clear. However, researchers believe that changes or mutations in certain genes may play a role in the development of these tumors.
Risk Factors and Frequency for Pancreatic Serous Cystadenoma
Pancreatic serous cystadenomas, a kind of cystic condition in the pancreas, make up a third of such conditions. They almost always turn out to be benign and are found more often in women. People usually discover these when they are between 50 and 70 years old, with the average age being 62. These lesions are most often found in the body or tail part of the pancreas. In people with a condition known as von Hippel-Lindau syndrome, 77% develop pancreatic cystic, and 9% of these are serous cystadenomas.
- Pancreatic serous cystadenomas comprise a third of all pancreatic cystic conditions.
- These cysts are largely benign and are found more in women.
- Most commonly, these are diagnosed in people between the age ranges of 50 to 70, with an average age of 62.
- The body or tail section of the pancreas is where these lesions usually occur.
- In cases of von Hippel-Lindau syndrome, 77% of patients develop pancreatic cystic conditions, and 9% of these are identified as serous cystadenomas.
Signs and Symptoms of Pancreatic Serous Cystadenoma
Many people with pancreatic serous cystadenomas, a type of pancreatic cyst, may not show any specific signs or symptoms. Very often, these cysts are discovered by accident when someone has an ultrasound or imaging done for a different health problem. However, when symptoms do occur, the most common ones are abdominal pain or a feeling of a mass in the upper abdomen.
Less frequently, those with large cysts might experience symptoms similar to pancreatic ductal carcinoma. These might include:
- Abdominal pain
- Weight loss
- Feeling full quickly due to pressure on the stomach wall (gastric outlet obstruction)
- Obstructive jaundice, a condition where the flow of bile is blocked, which may result in acute cholangitis, a severe infection of the bile duct
- Pancreatic duct obstruction, which can harm the pancreas and lead recurrent pancreatitis
It’s also important to note that true cystic lesions can be mistaken for pseudocysts, as they can look similar. Pseudocysts usually develop after a pancreatitis attack or gradually due to chronic pancreatitis. They are often painful and large ones can press on the stomach, leading to vomiting, early satiety, or obstructive jaundice.
Testing for Pancreatic Serous Cystadenoma
The strategy for evaluating pancreatic cystic neoplasms (PCNs), or fluid-filled sacs in the pancreas, involves using lab tests and imaging techniques to identify the different types based on their shape and the way they appear on scans. Over the last 15 years, the detection of PCNs has increased tremendously, mainly due to advanced imaging techniques like CT scans and MRIs.
These imaging techniques have identified four types of pancreatic serous cystadenoma patterns. The microcystic pattern consists of many small cysts that are less than 2 cm and look like honeycomb. When cysts are 2 cm or larger, it’s known as a macrocystic type. Mixed microcystic and macrocystic types have both small and large cysts. A solid type consists of a tumor without any cysts.
Different imaging techniques have different ways of identifying these patterns. For instance, an ultrasound can show these adenomas as well-defined, with different areas appearing differently due to their components. On a CT scan, these types of adenomas usually have a lobular shape and appear less dense than surrounding tissue because they primarily consist of water-like density. When contrast material is used, it allows the fibrous parts of the tumor to be enhanced. The enhancement pattern is an important feature that helps distinguish this type of tumor.
Identifying these patterns can sometimes be tricky because they can look like other types of cysts, but MR imaging is used to further characterize the lesion. On an MRI, the cystic areas appear lighter or darker than other areas depending on the type of imaging technique used. MRI is better at detecting fluid, especially in the case of microcysts.
When endoscopic ultrasound (a minimally-invasive procedure using sound waves to create images) is used with other imaging techniques, it can improve the accuracy of the diagnosis because it can detect smaller areas of closely arranged microcysts. It can also provide a more definite diagnosis by obtaining samples for analysis.
The fluid in pancreatic cysts can also be analyzed to help identify these cysts and differentiate serous cystadenoma from malignant or mucinous cysts. This analysis includes looking at chemical levels, such as amylase (an enzyme that helps break down carbohydrates), and tumor markers, which are substances found in higher-than-normal amounts in the blood, urine, or body tissues of some people with certain types of cancer. In serous cystadenoma, the fluid usually shows low levels of these chemicals and markers.
Treatment Options for Pancreatic Serous Cystadenoma
If you have a pancreatic serous cystadenoma, which is a type of non-cancerous tumor in the pancreas, your doctor will typically suggest a non-surgical approach if you don’t have any symptoms. This is because these cysts tend to grow very slowly and there’s a very small chance (less than 3%) of them turning into cancer. So, it’s safe for your doctor to keep an eye on them through regular imaging tests.
However, if the cysts are causing symptoms, are growing quickly, or are extremely large (more than 4 inches or 10 cm in size), your doctor will likely recommend surgery. This can be the case if the cysts cause problems like blocking the bile flow (causing yellow skin or eyes, known as jaundice), obstructing the flow in the pancreatic duct, or causing issues with your stomach emptying its content properly.
Even when larger cysts don’t typically indicate cancer, they tend to grow faster than small cysts, making it more likely they’ll cause symptoms. Surgical treatment may also be required if your doctor can’t rule out the presence of cancer.
The type of surgery will depend on where the cyst is located within the pancreas. Possibilities include removing the left side of the pancreas (distal pancreatectomy), with or without also removing your spleen, removing the middle portion of the pancreas (mid pancreatectomy), or a more complex operation called a ‘Whipple procedure’. Previously, some doctors would remove only the cyst itself (enucleation), a less invasive option for carefully selected patients. This approach helps to preserve the pancreas’s function, which includes producing enzymes that aid in digestion (exocrine function) and releasing hormones like insulin into the bloodstream (endocrine function).
What else can Pancreatic Serous Cystadenoma be?
Determining the exact diagnosis of cysts in the pancreas can be challenging, especially when only relying on imaging studies. Most of these cystic formations in the pancreas are a result of inflammation, being referred to as pseudocysts, while a smaller percentage are considered to be growths, or neoplasms.
The challenge also includes differentiating benign fluid-filled growths (serous) from mucus-filled (mucinous cystic neoplasm) and cancerous mucus-filled lesions (mucinous cystadenocarcinoma). By using imaging tests, studies of physical form, and laboratory tests, these types of cysts can be identified before removal and their potential to turn into malignancy can be evaluated. Distinguishing pseudocysts from serous lesions is vital for deciding the best surgical approach.
There are some uncommon types of pancreatic cystic lesions, which include cystic islet cell tumors, papillary cystic lesions, and lymphoepithelial cysts. The possible conditions for serous cystadenomas (a type of benign cyst) include:
- Non-neoplastic pancreatic cysts: true cysts, retention cysts, mucinous non-neoplastic cysts, lymphoepithelial cysts.
- Pancreatic cystic growths include mucinous, intraductal papillary mucinous growths and solid pseudopapillary growths.
- Cystic degeneration in solid pancreatic tumors includes ductal carcinoma, acinar cell carcinoma, and endocrine tumors.
What to expect with Pancreatic Serous Cystadenoma
Serous cystadenomas are mostly benign (not harmful), with only a tiny chance (under 3%) of them turning cancerous. In a long-term study involving 18 patients with these tumors, changes were noticed in 3 tumors (17%). Here’s what happened: in one case, the tumor changed from a microcystic (small cysts) serous cystadenoma to a macrocystic (large cysts) one, and the tumor grew larger. In the second case, a macrocystic serous cystadenoma developed small cysts, resulting in a mix of both types, and the tumor grew in size. In the third patient, a macrocystic serous cystadenoma turned into a microcystic one, and the tumor shrunk from 30 mm to 25 mm.
Looking at all 18 patients, nine of them (50%) saw their tumors grow, while the other nine had no change in the size of their tumors. On average, these tumors grew at a rate of 0.29 cm each year. But the good news is that the outlook for patients with serous cystadenomas is generally very positive.
Even in the infrequent situation where the serous cystadenomas became cancerous (referred to as serous cystadenocarcinomas), reports show that patients could still live for a long time following surgery. Research also indicates that these tumors all have the potential to grow over time, regardless of the tumor’s subtype, size, or location. Because of this, it’s advised that all people with these types of tumors should have regular medical check-ups.
Possible Complications When Diagnosed with Pancreatic Serous Cystadenoma
Doctors have to weigh the pros and cons of doing regular scans vs. surgery. The death rate from surgery could be higher than we think. Problems after pancreatic surgery tend to be common both immediately after and in the long-term. These can include the formation of abnormal connections in the pancreas and around one in three patients can experience reduced pancreatic functions, which can cause conditions like diabetes.
If a type of pancreatic tumor called serous cystadenomas continues to grow without treatment, it can result in several serious health issues. These can include inflammation of the pancreas, blockage of the bile ducts leading to a condition known as jaundice, an infection of the bile ducts, reduced pancreatic functions due to blockage of the pancreatic duct, or blockage of the passage from the stomach to the intestine.
The Risks of Untreated Pancreatic Issues:
- Inflammation of the pancreas
- Blockage of the bile ducts leading to jaundice
- Infection in the bile ducts
- Reduced pancreatic function due to blockage of the pancreatic duct
- Blockage of the passage from the stomach to the intestines
Preventing Pancreatic Serous Cystadenoma
It’s crucial to reassure and educate patients, as the majority of serous cystadenomas, a type of growth, are not harmful. These growths are often found accidentally during body scans. Patients knowing their own and their family’s medical history, especially past episodes of pancreatitis, can greatly help. Pancreatitis can sometimes result in pseudocysts or be associated with genetic familial syndromes that can lead to abnormalities in the pancreas, such as VHL syndrome.
Patients should be advised to keep an eye out for new symptoms like yellowing of the skin or eyes (jaundice), stomach pain, and feeling full quickly after eating (early satiety). These could point to more complex conditions and will need further tests to rule out growths in the pancreas.
Furthermore, educating patients on the importance of regular check-ups and scans is vital. If the growth increases in size or shows any signs of abnormal cell changes (dysplasia), it could significantly impact the patient’s chances of survival and the treatment outcome.
