Comparative analysis of hypervascular microcystic serous cystadenoma with MRI and immunohisto-chemistry

Abstract

PURPOSE: Cystic tumors of the pancreas are increasingly common lesions. Unlike mucinous cystic tumors, serous cystadenomas are benign lesions and do not pose a risk of cancer. Often seen in women in the 6th and 8th decades, they are rarely seen in younger women or in male patients. Serous cystadenomas do not require surgical treatment unless they produce symptoms due to compression. Sometimes they may be misdiagnosed as cystic neuroendocrine tumors and resec-ted because of the contrast enhancement on contrast enhanced cross-sectional studies. The purpose of this article is a translational analysis of why a cystic tumor enhances. MATERIAL and METHODS: The preoperative T2 HASTE, fat-suppressed T2 Turbo Spin Echo sequences, magnetic resonance cholangiopancreatography, diffusion weighted images, ex-vivo high-resolution T2 HASTE images of the post-ope-rative pathologic specimen and immunohistochemical analysis with vascular marker CD31 were compared in a 58-year-old male patient with a pancreatic corpus microcystic serous cystadenoma. RESULTS: The nodular lesion is observed as fluid signal in T2 weighted sequences and enhancing in postcontrast series. Ex-vivo high-resolution MRI has also revealed cysts with millimetric different sizes and septations within the lesion. Evaluation with the CD31 vascular marker showed that fibrous septa between the cysts were dense vascular and stained. CONCLUSION: We show here that microcystic serous cystadenomas have intense vascularity of their septations that enhance in cross-sectional studies, especially when the cyst diameter is smaller. © 2019, Edizioni Luigi Pozzi. All rights reserved.