Pancreas
Exocrine tumors / carcinomas
Serous cystadenoma

Author: Deepali Jain, M.D. (see Authors page)

Revised: 20 December 2017, last major update August 2012

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Serous cystadenoma[TI] pancreas[TI]

Cite this page: Jain, D. Serous cystadenoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/pancreasserous.html. Accessed February 20th, 2018.
Definition / general
Clinical features
  • Mean age 66, 70% women, associated with von Hippel-Lindau syndrome
  • Symptoms: none, local discomfort / pain, obstruction if in pancreatic head; may cause diabetes if tumor destroys enough islets
  • Excision is almost always curative
  • One malignant case reported, histologically benign but metastasized to stomach and liver and invaded spleen (Am J Surg Pathol 1989;13:61)
Case reports
Gross description
  • Large (mean 11 cm) multiloculated mass, sharply outlined, cysts filed with clear fluid
  • Spongy
  • Resembles infantile polycystic kidney
  • Often has central stellate scar
  • Rarely is multicentric, usually in tail or body
  • Either macrocystic (megacystic, oligocystic, usually < 10 cysts, Hum Pathol 1992;23:871) or microcystic (1 - 3 mm)
  • Large tumor size and head location predict aggressive behavior
Gross images

Images hosted on PathOut server:

Well demarcated cystic lesion with central stellate scar in tail of pancreas; cysts are filled with watery fluid and separated by thin septa



Images contributed by Dr. Hanni Gulwani, New Delhi (India):

76 year old man with incidental pancreatic mass



Images hosted on other servers:

Circumscribed,
sponge-like cut
surface with central
stellate scar

Solid variant

Microscopic (histologic) description
  • Small cystic spaces lined by small cuboidal cells with clear cytoplasm (glycogen), minimal mucin, myoepithelial layer present, round hyperchromatic central nuclei
  • Minimal papillae, has islets between lobules which may calcify (radiating pattern), tumor is vascular (seen by selective angiography)
  • Occasionally has papillary features (Arch Pathol Lab Med 2001;125:1591)
  • Rarely oncocytic change; rarely massive cystic degeneration resemble pseudocyst (Am J Surg Pathol 2012;36:726)
  • Fluid has low CEA content compared to mucinous cystic neoplasms
  • Solid variant: rare, similar microscopically to serous cystadenoma but no cystic spaces; cells arranged in nests, sheets and trabeculae separated by thick fibrous bands; has PAS+ cytoplasm (glycogen); may histologically resemble sugar tumor, clear cell carcinoma, clear cell pancreatic endocrine tumor, renal cell carcinoma but benign behavior (Am J Surg Pathol 1996;20:1401)
Microscopic (histologic) images

Images hosted on PathOut server:

Cysts exhibit marked
size variation (larger
at periphery, smaller
and uniform centrally)

Tumor cell cytoplasm is PAS+ due to glycogen

Intracystic papillary
projection is
formed by regular
cuboidal cells

Cystic lesion is well demarcated from adjoining pancreas by small fibrous band containing some vessels


Cuboidal cells with watery clear cytoplasm (due to glycogen), with round dense nuclei but no atypia; sparse stroma between cysts, cystic content has no significant staining

Serous cystadenocarcinoma - left: 71 year old patient with metastasizing tumor resembling a serous cystadenoma, cysts of variable size and focal papillary projections; right: lymph node metastasis of left tumor



Images contributed by Dr. Hanni Gulwani, New Delhi (India):

76 year old man with incidental pancreatic mass



Images hosted on other servers:

Cuboidal cells with watery clear cytoplasm (due to glycogen), with round dense nuclei but no atypia; sparse stroma between cysts, cystic content has no significant staining

Various images

Papillary variant

Solid variant

Negative stains
Electron microscopy description
  • Prominent microvilli, glycogen granules, epithelial cells connected by occluding junctions and belt desmosomes resting on a basement membrane
  • No neurosecretory or zymogen granules
Electron microscopy images

Images hosted on PathOut server:

Cytoplasm has multiple glycogen particles, some mitochondria and multivesicular bodies but no microvilli are present at the apical surface

Molecular / cytogenetics description
Differential diagnosis