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CT of Serous Cystadenoma of the Pancreas and Mimicking Masses

Hyoung Jung Kim1, Dong Ho Lee1, Young Tae Ko1, Joo Won Lim1, Hyun Cheol Kim2 and Kyoung Won Kim3

1 Department of Radiology, Kyung Hee University Medical Center, 1, Hoegi-dong, Dongdaemun-gu, Seoul 130-702, Korea.
2 Department of Radiology, East–West Neo Medical Center, Kyung Hee University, Seoul, Korea.
3 Departments of Radiology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.


Figure 1
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  		Fig. 1A —67-year-old woman with serous cystadenoma, polycystic pattern. Pancreatic phase CT axial (A) and coronal (B) reformations show cystic lesion (arrows) in tail of pancreas. Cyst has many loculi, thin septa, external lobulation, and central scar with stellate calcification (arrowhead).

 

Figure 2
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  		Fig. 1B —67-year-old woman with serous cystadenoma, polycystic pattern. Pancreatic phase CT axial (A) and coronal (B) reformations show cystic lesion (arrows) in tail of pancreas. Cyst has many loculi, thin septa, external lobulation, and central scar with stellate calcification (arrowhead).

 

Figure 3
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  		Fig. 2A —61-year-old woman with intraductal papillary mucinous neoplasm, branch duct type. Portal venous phase CT coronal reformations show grapelike cystic lesion (arrows) in head of pancreas. Cystic components have varied appearance. Note thin communication (arrowhead, A) between pancreatic duct and cystic lesion.

 

Figure 4
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  		Fig. 2B —61-year-old woman with intraductal papillary mucinous neoplasm, branch duct type. Portal venous phase CT coronal reformations show grapelike cystic lesion (arrows) in head of pancreas. Cystic components have varied appearance. Note thin communication (arrowhead, A) between pancreatic duct and cystic lesion.

 

Figure 5
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  		Fig. 3 —38-year-old woman with mucinous cystadenoma. Portal venous phase CT coronal reformation shows round cystic lesion (arrows) in tail of pancreas. Lesion has multiple internal septa (arrowheads). Note smooth contour without lobulated margin.

 

Figure 6
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  		Fig. 4A —46-year-old man with serous cystadenoma, honeycomb pattern. Portal venous phase CT coronal reformation shows low-attenuation mass (arrows) in tail of pancreas. Mass has slightly higher attenuation than that of water in stomach (S). Note multiple thin internal septa (arrowheads). Internal honeycomb pattern is difficult to appreciate.

 

Figure 7
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  		Fig. 4B —46-year-old man with serous cystadenoma, honeycomb pattern. Oblique coronal T2-weighted MR image clearly shows honeycomb pattern (arrows) and central fibrous scar (arrowhead).

 

Figure 8
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  		Fig. 4C —46-year-old man with serous cystadenoma, honeycomb pattern. Photograph of cut surface of specimen shows central scar (arrowhead) and innumerable tiny cysts, similar to those of T2-weighted image (B).

 

Figure 9
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  		Fig. 5A —49-year-old woman with serous cystadenoma, honeycomb pattern. Pancreatic phase CT scan shows small inhomogeneous mass (arrows) in head of pancreas. Anterior portion of tumor (arrowhead) shows high enhancement and other portions show intermediate to low enhancement.

 

Figure 10
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  		Fig. 5B —49-year-old woman with serous cystadenoma, honeycomb pattern. Portal venous phase CT scan shows inhomogeneous mass (arrows). Portion that had high enhancement in A now shows decreased enhancement (arrowhead). Honeycomb pattern is difficult to identify on this CT image.

 

Figure 11
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  		Fig. 5C —49-year-old woman with serous cystadenoma, honeycomb pattern. Axial T2-weighted MR image clearly shows honeycomb pattern (arrows) and central fibrous scar (arrowhead).

 

Figure 12
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  		Fig. 6 —20-year-old woman with islet cell tumor. Pancreatic phase CT shows characteristic ring enhancement pattern (arrows). Note central low attenuation compatible with probable necrosis (arrowhead).

 

Figure 13
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  		Fig. 7 —27-year-old woman with solid pseudopapillary tumor. Portal venous phase CT scan shows large mass (arrows) in head of pancreas. Mass shows inhomogeneous enhancement, which is suggestive of necrosis or hemorrhage.

 

Figure 14
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  		Fig. 8A —57-year-old woman with serous cystadenoma, honeycomb pattern. Portal venous phase CT scan shows hypervascular mass in tail of pancreas. Central fibrous scar (arrowhead) is seen as low density.

 

Figure 15
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  		Fig. 8B —57-year-old woman with serous cystadenoma, honeycomb pattern. Sonogram obtained in similar plane to that of A shows large echogenic mass posterior to stomach (S). Note increased through-transmission (arrows) posterior to mass. Pathologic specimen (not shown) showed solid-appearing mass with multiple small cysts and central fibrous scar. Small hemorrhage was present at medial aspect of mass.

 

Figure 16
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  		Fig. 9A —44-year-old woman with unilocular serous cystadenoma. Portal venous phase CT scan shows unilocular cystic lesion surrounded by imperceptible wall. Lesion shows lobulated margin (arrow).

 

Figure 17
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  		Fig. 9B —44-year-old woman with unilocular serous cystadenoma. Photograph of cut surface of specimen shows unilocular cystic lesion with lobulated margin (arrow), characteristic of serous cystadenoma.

 

Figure 18
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  		Fig. 10 —53-year-old man with pancreatic pseudocyst. Portal venous phase CT scan shows unilocular cyst surrounded by prominent enhancing wall (arrow) in tail of pancreas. Note infiltration (arrowheads) in peripancreatic fat, which is suggestive of pancreatitis.

 

Figure 19
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  		Fig. 11 —47-year-old woman with mucinous cystadenoma. Portal venous phase CT scan shows round cystic lesion. Medial wall of cystic lesion (arrow) is slightly thickened. Lobulated margin is not seen.

 

Figure 20
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  		Fig. 12A —11-year-old girl with solid pseudopapillary tumor. Unenhanced CT scan shows round lesion (arrows) in tail of pancreas. Lesion appears heterogeneous with central area of high attenuation (arrowhead), which is suggestive of hemorrhage.

 

Figure 21
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  		Fig. 12B —11-year-old girl with solid pseudopapillary tumor. On portal venous phase CT scan, unilocular cystic lesion surrounded by enhancing wall (arrows) is noted. Pathologic specimen (not shown) showed cystic lesion filled with hemorrhage.

 

Figure 22
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  		Fig. 13A —55-year-old man with oligocystic serous cystadenoma. Portal venous phase CT scan shows cystic lesion (arrow) in tail of pancreas, consisting of several loculi and subtle enhancing septa. Note lobulated contour of cystic lesion.

 

Figure 23
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  		Fig. 13B —55-year-old man with oligocystic serous cystadenoma. On MR cholangiopancreatography, cystic lesion (arrows) consists of several loculi and has lobulated contour.

 

Figure 24
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  		Fig. 14A —44-year-old man with unilocular serous cystadenoma. Portal venous phase CT scan shows unilocular cystic lesion surrounded by thin nonenhancing wall (arrow) in body of pancreas. Subtle lobulated margin (arrowhead) was missed on initial evaluation.

 

Figure 25
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  		Fig. 14B —44-year-old man with unilocular serous cystadenoma. Endoscopic sonogram shows unilocular cystic lesion (arrows) with lobulated margin (arrowhead), which was missed on CT.

 

Figure 26
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  		Fig. 15A —41-year-old woman with serous cystadenoma, disseminated variant. Serial images from portal venous phase CT show multiple cysts replacing entire pancreas. Right nephrectomy was performed 5 years earlier because of renal cell carcinoma. Surgical clips (arrow, B) are seen in right renal fossa.

 

Figure 27
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  		Fig. 15B —41-year-old woman with serous cystadenoma, disseminated variant. Serial images from portal venous phase CT show multiple cysts replacing entire pancreas. Right nephrectomy was performed 5 years earlier because of renal cell carcinoma. Surgical clips (arrow, B) are seen in right renal fossa.

 

Figure 28
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  		Fig. 16A —44-year-old woman with serous cystadenoma. Pancreatic phase CT scan shows cystic lesion (arrow) in neck of pancreas. Lesion has lobulated contour and thin septa.

 

Figure 29
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  		Fig. 16B —44-year-old woman with serous cystadenoma. Seven months later, cystic lesion (arrow) shows increase in diameter on pancreatic phase CT scan. Small amount of hemorrhage was present in several loculi of serous cystadenoma on pathologic specimen (not shown).

 

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