Johns Hopkins Pathology
 
Key Points:
  • Mucinous Cystic Neoplasm

Given the characteristic gross and microscopic appearance of serous cystadenomas, the diagnosis is usually relatively easy and straightforward. Nonetheless, establishing the correct diagnosis of a cystic lesion in the pancreas is important for clinical management and a broad differential diagnosis should be kept in mind.

Mucinous cystic neoplasms, because of their significantly greater malignant potential, are probably the most important neoplasms to consider in the differential diagnosis. In particular, serous oligocystic cystadenomas, because they are composed of larger cysts, can grossly mimic mucinous cystic neoplasms. While both serous and mucinous cystic neoplasms will be cystic, the cysts in mucinous cystic neoplasms tend to be larger and are filled with thick tenacious fluid, not the clear watery fluid of serous cystadenomas. At the microscopic level mucinous cystic neoplasms will be lined by tall columnar cells containing abundant mucin, while the lining in serous cystadenomas is cuboidal and glycogen-rich. Mucicarmine and other stains for mucin will stain mucinous cystic neoplasms and not serous cystadenomas. Both neoplasms will express cytokeratin, but only the mucinous cystic neoplasms will label with antibodies to carcinoembryonic antigen. In cases in which the epithelium is extensively denuded, the presence of “ovarian-type” stroma can be used to establish the diagnosis of a mucinous cystic neoplasm.

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