• Charnwit Assawasirisin, Motaz Qadan, Satita Aimprasittichai, Avinash Kambadakone, Maximiliano Servin-Rojas, Andrew L Warshaw, Keith D Lillemoe, and Carlos Fernández-Del Castillo.
• Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
• Ann. Surg. 2025 Mar 1; 281 (3): 501507501-507.

ObjectiveTo understand the natural history of serous cystadenoma (SCA), and the diagnostic accuracy of SCA and identify possible factors that lead to the correct diagnosis.BackgroundSCA is a benign cystic pancreatic neoplasm of the pancreas, accounting for ~15% of resected pancreatic cysts. Current recommendations are to proceed with surgical resection in symptomatic patients or when there is uncertainty regarding diagnosis. The latter continues to be a challenge since intentional resection of an SCA accounts for only a minority of resected cases.MethodsRetrospective single-institution review of patients who on final pathology had a diagnosis of pancreatic SCA and of patients who had this diagnosis and were managed nonoperatively. Demographic data, cyst characteristics, and growth rate were collected for analysis.ResultsA total of 250 patients were analyzed. Median age was 62 (range: 22-89), 65% were females, and 34% had symptoms. Tumor size ranged from 0.6 to 20, with a median of 3.4 cm. The morphologic appearance was microcystic in 58%, macrocystic in 16%, mixed-type in 23%, and solid in 3%. Pancreatic duct dilation and pancreatic atrophy were found in 22% and 14%, respectively. The average growth rate was 1.8 mm/year regardless of tumor size. Of the 172 patients who underwent surgery, SCA was the preoperative diagnosis in only 33%. A correct diagnosis was independently associated with large tumors and cyst fluid carcinoembryonic antigen analysis. Pancreatic duct dilation was independently associated with an in-growing cyst and the presence of calcification.ConclusionsSCA is a slow-growing pancreatic cystic neoplasm that is mostly asymptomatic but can lead to pancreatic duct dilation and atrophy in some patients. A surprisingly small number of correct preoperative diagnoses confirms that this entity continues to be a diagnostic challenge. A more thorough preoperative workup that includes endoscopic ultrasonography should improve the rate of misdiagnosis.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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