Pankreasin seröz kistadenomu (Mikrokistik adenom):
Olgu sunumu
Serous cystadenoma of the pancreas (Microcystic adenoma): Case report
Özet
Seröz kistadenom pankreasin nadir gözlenen benign kistik bir lezyonudur. Bu lezyonlar, abdominal kitle, gastrointestinal sistem ya da safra yollari obstrüksiyonu seklinde bulgu verebilecekleri gibi, insidental olarak da gözlenebilirler. Bu makalede epigastrik agri, bulanti, kusma sikayetleri ile basvuran, koledokolithiazis ön tanisi ile ameliyata alinan 82 yasinda kadin hasta sunulmustur. Olgunun operasyon sirasinda pankreas basi bölgesinde nodülarite saptanmasi üzerine Whipple operasyonu yapi lmistir. Spesimen üzerinde, pankreas basinda bal-pategi görünümde alan izlenmis olup; mikroskopik olarak küçük, yuvarlak santral yerlesimli nükleuslara sahip, seffaf sitoplazmali küboidal hücrelerin dösedigi çok sayida kist yapilari gözlendi. Patern olarak anaplazi kriterleri izlenmedi ve mitoz yönünden inaktif idi. Histokimyasal olarak "Periodic acid-Shiff" ile hücre sitoplazmalarinda, immünohistokimyasal olarak ise "Epithelial Membrane Antigen" ile lüminal yüzde, düsük molekül agirli kli keratin ile tümör hücre sitoplazmalarinda reaksiyon izlendi. Bu bulgularla olgu seröz kistadenom olarak rapor edildi. Seröz kistadenom, pankreasin az gözlenen kistik bir neoplazmi olmasina ragmen, ayirici tani da pankreasin diger kistik tümörleri ve yani sira neoplastik olmayan kistleri de akilda tutulmalidir.
Abstract
Serous cystadenoma is a rarely seen benign cystic lesion of the pancreas. These lesions manifest with the symptoms of abdominal mass and gastrointestinal and bile duct obstruction, or may be seen incidentally. Herein we report an 82-year-old woman presenting with epigastric pain, nausea and vomiting with a pre-diagnosis of cholelithiasis. Whipple operation had been performed due to a nodularity seen at the head of the pancreas. The operation specimen revealed a well circumscribed mass with multiple tiny cysts giving the tumor a honeycomb appearance; multiple cysts lined by small, cuboidal cells having centrally located nucleus with clear cytoplasm were seen microscopically. There seemed to be no signs of anaplasia and the lesion was mitotically inactive. Histochemically positive staining was revealed in the cell cytoplasms with periodic acid-Schiff. Immunohistochemically with epithelial membrane antigen, staining was seen at the luminal surfaces of the cells, and with low molecular weight keratin, positive reaction was seen in the cytoplasms of the tumor cells. The lesion was thus diagnosed as serous cystadenoma based on these findings. Despite its rarity, serous cystadenoma should be kept in mind in the differential diagnosis of the cystic tumors as well as other non-neoplastic cysts of the pancreas.
