Serous cystadenoma of the pancreas: tumor growth rates and recommendations for treatment

Abstract

Objective: To define the natural history and optimal management of serous cystadenoma of the pancreas.

Summary background data: Serous cystadenoma of the pancreas is the most common benign pancreatic neoplasm. Diagnostic criteria, potential for growth or malignancy, and outcomes are not well defined. As a result, management for patients with serous cystadenomas varies widely in current practice.

Methods: A total of 106 patients presenting with serous cystadenoma of the pancreas from 1976-2004 were identified. Hospital records were evaluated for patient and tumor characteristics, diagnostic workup, treatment, and outcome. Twenty-four patients with serial radiographic imaging were identified, and tumor growth curves calculated.

Results: Mean age at presentation was 61.5 years and 75% of patients were female. The most common symptoms were abdominal pain (25%), fullness/mass (10%), and jaundice (7%); 47% were asymptomatic. Mean tumor diameter was 4.9 +/- 3.1 cm, which did not vary by location. Tumors <4 cm were less likely to be symptomatic than were tumors > or =4 cm (22% vs. 72%, P < 0.001). The median growth rate in the patients who had serial radiography was 0.60 cm/y. For tumors <4 cm at presentation (n = 15), the rate was 0.12 cm/y, whereas for tumors > or =4 cm (n = 9), the rate was 1.98 cm/y (P = 0.0002). Overall, 86 patients underwent surgery, with one perioperative death.

Conclusions: Large (>4 cm) serous cystadenomas are more likely to be symptomatic. Although the median growth rate for this neoplasm is only 0.6 cm/y, it is significantly greater in large tumors. Whereas expectant management is reasonable in small asymptomatic tumors, we recommend resection for large serous cystadenomas regardless of the presence or absence of symptoms.

FIGURE 1. Serous cystadenoma involving the entire pancreas. A, CT scan. B, Cut specimen. The patient was 64-years-old and had postprandial fullness and a palpable mass.

FIGURE 2. Serous cystadenoma tumor growth over time. Open circles represent tumors <4 cm at presentation, solid squares represent tumors ≥4 cm at presentation.

FIGURE 3. Comparison of tumor growth for serous cystadenomas <4 and ≥4 cm in maximum diameter.

FIGURE 4. Serial radiographs in an 81-year-old woman with an incidentally discovered serous cystadenoma of the head of the pancreas. The tumor measured 5 × 5.5 cm in September 2003. By April 2004 the patient was complaining of dull epigastric pain, and the tumor measured 5.5 × 6.1 cm.

FIGURE 5. Diagnostic and management algorithm for suspected serous cystadenoma of the pancreas.