P1538 - Role of Endoscopic Ultrasound in a Rare Presentation of a Diffuse Serous Cystadenoma of the Pancreas

Aida Rezaie, MD¹, Ria Kundu, MD², Savio Reddymasu, MD^3
1Creighton University, Mesa, AZ; ²Banner Health, Mesa, AZ; ³Creighton University, Phoenix, AZ

Introduction: Pancreatic serous cystadenomas are the most common benign lesions of the pancreas discovered incidentally on cross-sectional imaging. They typically present in women between the fifth and seventh decade of life in the body or tail of the pancreas. Computed tomography (CT) findings of a serous cystadenoma include a central scar with a “honeycomb” appearance of microcysts. While the etiology is unclear, there may be a genetic component as around 77% of patients with von Hippel-Lindau develop pancreatic lesions, of which 12% are serous cystadenomas. Management depends on patient symptoms and the size of the serous cystadenoma. Surgical resection is usually recommended if it is greater than 4 cm. We present a rare case of a diffuse serous cystadenoma that occupied nearly the entire pancreas, and role of EUS-guided biopsy to not only diagnose this lesion but guide management.

Case Description/Methods: 69 year old presented with left upper quadrant pain for 2 weeks that had since resolved. Computed tomography of the abdomen and pelvis scan showed a large, multiseptated cystic lesion, approximately 12.5 x 17.8 x 16 cm, occupying the majority of the native pancreas. The patient subsequently underwent Endoscopic ultrasound (EUS) with fine needle aspiration which revealed that the entirety of the pancreas was replaced by a large multiseptated cystic lesion in which the largest locule measured 2 cm. The pancreatic duct could not be visualized, no peripancreatic of celiac axis lymphadenopathy was seen and the surrounding vasculature appeared patent. The pancreatic fluid CEA was 3.0 ng/mL and Amylase 35 U/L. The patient was subsequently diagnosed with a diffuse serous cystadenoma of the pancreas.

Discussion: Serous cystadenomas are typically in the body-tail of the pancreas allowing for partial pancreatectomy as a treatment option. EUS-guided FNA is the primary modality to characterize, diagnose and guiding management of complex pancreatic lesions. This is a rare case of a diffuse serous cystadenoma occupying the entirety of the pancreas which would require a complete pancreatectomy. After careful discussion with the patient regarding the risks and benefits, the patient elected to undergo serial imaging with an MRI in 3 months.



Disclosures:


Aida Rezaie, MD¹, Ria Kundu, MD², Savio Reddymasu, MD³. P1538 - Role of Endoscopic Ultrasound in a Rare Presentation of a Diffuse Serous Cystadenoma of the Pancreas, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.