Serous Cystic Tumors
The serous cystic tumor (SCT) of the pancreas is most often incidentally detected when an imaging study is performed for clinical symptoms which may or may not be directly related to the pancreas. Once detected, accurate characterization of a pancreatic mass as an SCT is of primary importance since this tumor is benign, unlike all the other cystic tumors of the pancreas. There are no more than 10 reports of serous cystadenocarcinoma in the world literature (GEORGE et al. 1989; SOYER et al. 1994; KLöPPEL et al. 1996; WIDMAIER et al. 1996; ABE et al. 1998; ERIGUCHI et al. 1998; WU et al. 1999). Authors are still not in complete agreement about the therapeutic management of SCT. Reports are divided in the surgical literature between those who advocate resection in all cases (PADOVANI et al. 1991; TALAMINI et al. 1992; NAGEL et al. 2000; BOX and DOUGLAS 2000; SHEENAN et al. 2000) and those who accept the imaging diagnosis of SCT, allowing the lesions to be followed (ISELIN et al. 1993; SARR et al. 2001). Conservative management is favored in patients with large masses who are asymptomatic; elderly patients or those who may be poor surgical candidates; lesions in the pancreatic head where the morbidity and mortality associated with pancreaticoduodenectomy may be higher than the presence of the untreated lesion; and above all, those small tumors which occasionally show up in otherwise completely healthy or young patients (KIMURA and MAKUUCHI 1999). COMPAGNO and OERTEL (1978a, b) originally observed the anatomic-pathological appearance of SCT. Their studies characterized the morphology of all cystic lesions containing serous fluid as ‘microcystic’. This unique morphology narrows down the differential diagnosis of pancreatic masses with this appearance. This classification has been further expanded by the identification of an oligocystic type (KLöPPEL et al. 1996; SOLCIA et al. 1997), resulting in a considerable increase in differential diagnosis problems.
KeywordsCystic Tumor Compute Tomography Evaluation Serous Cystadenoma Central Scar Serous Cystadenocarcinoma
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