Serous microcystic adenoma of the head of the pancreas causing an obstructive jaundice

Abstract

Background. Serous microcystic adenoma is a rare benign tumor of the exocrine pancreas originating from the ductal system and composed of a large number of small cysts covered by cuboid cells, filled with clear serous fluid and separated with fibrocolagenous stroma. Most frequently it appears in women in 7th and 8th decades, in the distal pancreas. It shows a very low malignant potential. In 2/3 of patients symptoms are uncharacteristic and in 1/3 they are absent. When localized within the head of the pancreas it rarely causes an obstructive jaundice. Case report. We presented a 61-year-old female patient who for months had had mild and nonspecific abdominal symptoms developing to progressive obstructive jaundice. At surgery we revealed a rather large policystic mass of the head of the pancreas causing not only obstructive jaundice but also a venous stasis by compression and dislocation of the portomesenteric vein. The tumor was removed with pylorus preserving cephalic duodenopancreatectomy (Whipple's procedure modified by Longmire-Traverso). Histology confirmed serous microcystic adenoma of the pancreas. The postoperative recovery was uneventful and preoperative symptoms disappeared. Conclusion. Although very rare, serous microcystic adenoma might appear within the head of the pancreas and has to be taken into consideration in differential diagnosis of cystic lesions of the head of the pancreas. Very rarely the tumour might cause obstructive jaundice. Surgical resection, which might be demanding, leads to complete recovery.

Keywords

• pancreas
• exocrine
• adenoma
• diagnosis
• diagnosis
• differential
• jaundice
• obstructive
• pancreaticoduodenectomy