title: Macrocystic serous cystadenoma of the pancreas: Report of 4 cases.
abstract: BACKGROUND
  Macrocystic serous cystadenomas (MaSCA) are rare benign tumor of the pancreas which represent an atypical macroscopic morphologic variant of serous cystadenomas (SCA). They are characterized by a limited number of cysts with a diameter of >2 cm and share imaging features overlapping those of mucinous cystic neoplasm (MCN) and branch-duct intraductal papillary mucinous neoplasm (BD-IPMN), thus frequently making the pre-operative radiologic diagnosis difficult.
  
  
  METHODS
  Four cases of MaSCA, which were surgically treated in our structure, are reported.
  
  
  RESULTS
  Two women (62 and 39 year-old) presented with upper abdominal pain and palpable mass underwent CT with evidence of a lobulated cystic neoformation (98 × 70 and 94 × 75 mm respectively) originating from the body and the tail of the pancreas respectively. They underwent distal pancreatectomy for suspected MCN. A 38 year-old woman underwent laparoscopic distal pancreatectomy because of the incidental finding of an unilocular cystic lesion in the pancreatic tail (23 mm) of indeterminate origin (MCN, SCA or metastasis). In a 40 year-old woman, admitted for acalculous acute pancreatitis, an unilocular cystic lesion in the body of the pancreas (62 mm) was detected and confirmed after 2 months at CT, therefore she underwent distal pancreatectomy for suspected pseudocyst or SCA. In all of the 4 patients the histological examination of the specimens revealed a MaSCA.
  
  
  CONCLUSIONS
  Imaging techniques have a low diagnostic power in terms of differentiation of MaSCA from malignant lesions (as MCNs and BD-IPMN). In the clinical practise of MaSCA, surgery appears to gain indications that are wider than those correlated to the pathologic outcome, because of the necessity of a correct differential diagnosis from potentially malignant cystic tumors and the frequent symptoms requiring treatment.
authors.affiliation: Dipartimento di Scienze Mediche e Biologiche, Universitá degli Studi di Udine, Piazzale Kolbe, 4, 33100 Udine, Italy. Electronic address: riccardo.pravisani@gmail.com.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Pravisani
authors.affiliation: Dipartimento di Scienze Mediche e Biologiche, Universitá degli Studi di Udine, Piazzale Kolbe, 4, 33100 Udine, Italy. Electronic address: sergio.intini@uniud.it.
authors.forename: Sergio Giuseppe
authors.initials: SG
authors.lastname: Intini
authors.affiliation: Institute of Radiology, University Hospital "S. Maria della Misericordia", Udine, Italy. Electronic address: rossano.girometti@uniud.it.
authors.forename: Rossano
authors.initials: R
authors.lastname: Girometti
authors.affiliation: Institute of Pathology, University Hospital "S. Maria della Misericordia", Udine, Italy. Electronic address: claudio.avellini@uniud.it.
authors.forename: Claudio
authors.initials: C
authors.lastname: Avellini
authors.affiliation: Dipartimento di Scienze Mediche e Biologiche, Universitá degli Studi di Udine, Piazzale Kolbe, 4, 33100 Udine, Italy. Electronic address: cosimoleo@gmail.com.
authors.forename: Cosimo Alex
authors.initials: CA
authors.lastname: Leo
authors.affiliation: General Surgery, AUSL Umbria 2, Italy, PhD School of Biotechnologies, University of Perugia, Italy. Electronic address: walterbugiantella@alice.it.
authors.forename: Walter
authors.initials: W
authors.lastname: Bugiantella
authors.affiliation: Dipartimento di Scienze Mediche e Biologiche, Universitá degli Studi di Udine, Piazzale Kolbe, 4, 33100 Udine, Italy. Electronic address: andrea.risaliti@uniud.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Risaliti
mesh_terms: D000328:Adult; D001650:Bile Duct Neoplasms / Q000601:surgery; D003536:Cystadenocarcinoma / Q000601:surgery*; D018293:Cystadenoma, Serous / Q000601:surgery*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*
keywords: Cystic pancreatic neoplasm; Macrocystic; Pancreas; Serous cystadenoma