Pancreatic cystadenoma

Pancreatic cystadenomas are infrequent cystic neoplasms which include 2 different lesions: microcystic cystadenomas and mucinous cystadenomas. Over a 37 year period, we observed 25 pancreatic cystadenomas: 15 microcystic cystadenomas and 10 mucinous cystadenomas. The microcystic cystadenomas corresponded either to a localized tumor (13 cases) or multiple diffuse cystic lesions of similar histology occurring within the context of Von Hippel-Lindau disease (2 cases). Localized or multiple microcystic cystadenomas are benign tumors with no risk of degeneration. Mucinous cystadenomas are potentially malignant large unilocular or multilocular cystic tumors. Preoperative differentiation between the 2 types of cystadenomas is based essentially on ultrasound and computed tomography to a lesser extent on angiography. Localized microcystic cystadenomas are low-density, hypervascularized solid or mixed tumors. Mucinous cystadenomas are anechogenic, often show septation, and are water-dense and avascular. They should be differentiated from a microcystic cystadenoma with unilocular cyst features (2 cases in our series) and especially from pancreatic pseudocyst, particularly in case of a history of trauma and associated chronic pancreatitis (2 cases). Multiple microcystic cystadenomas should be differentiated from congenital polycystic disease of the pancreas. Determination of the benign or malignant nature of a mucinous cystadenoma is difficult despite the contribution of ultrasonically-guided percutaneous puncture and microbiopsy. Such samples are either insufficient or too limited, incurring the risk of over looking an area of localized degeneration. However, intraoperative biopsy of pancreatic cyst wall can correct an erroneous diagnosis of pseudocyst (1 case) and avoid inappropriate internal drainage. Total excision of mucinous cystadenomas represents the only suitable solution in view of the malignant potential of this tumor.(ABSTRACT TRUNCATED AT 250 WORDS)