An 84-year-old woman was admitted with melena. She had had an enlarging pancreatic
mass 2 years earlier requiring endoscopic retrograde cholangiopancreatography (ERCP)
with sphincterotomy and biliary metal stent placement. Her current presentation included
melena for 1 week. She did not have any pain, nausea, vomiting, abdominal fullness
or weight loss. Vital signs were within normal limits. On physical examination, mild
epigastric tenderness was present. Laboratory studies revealed hemoglobin of 6.6 g/dL,
a normal comprehensive metabolic profile, and normal serum lipase. Computed tomography
(CT) imaging revealed a 10.9 × 8.2 cm complex heterogeneously enhancing cystic pancreatic
head mass with multiple internal septations ([Fig. 1 a]). CT angiography reconstruction imaging showed a hypervascular pancreatic mass ([Fig. 1 b]). Endoscopy revealed friable duodenal mucosa from duodenal infiltration ([Fig. 2]). Cytologic examination through endoscopic ultrasound (EUS)-guided fine-needle aspiration
showed scant cellularity. The patient was diagnosed with serous cystadenoma of the
pancreas, although evolution to cystadenocarcinoma could not be excluded. Prophylactic
embolization of the gastroduodenal and inferior pancreaticoduodenal arteries was performed.
The patient was doing well at the time of last follow-up.
Fig. 1 An 84-year-old woman was admitted with melena. a CT imaging revealed a complex cystic pancreatic head mass with multiple internal
septations. b CT angiography reconstruction imaging showed a large hypervascular pancreatic lesion.
Fig. 2 Endoscopy revealed ulceration consistent with duodenal invasion.
Serous cystadenomas are benign tumors and represent about 30 % of primary cystic neoplasms
of the pancreas [1]. While some patients are asymptomatic at the time of diagnosis, most present with
abdominal pain, abdominal fullness/mass, jaundice or weight loss [2]. Duodenal wall invasion with erosion and bleeding as seen in our case is a rare
presentation of this benign lesion. A high degree of diagnostic reliability is crucial
in differentiating serous cystadenoma from serous cystadenocarcinoma, mucinous cystadenoma,
intraductal papillary mucinous neoplasms, or a pancreatic pseudocyst. CT imaging,
abdominal ultrasonography, and endoscopic ultrasound are usually diagnostically sufficient
although cyst fluid analysis can be helpful [2].
Endoscopy_UCTN_Code_CCL_1AB_2AZ_3AD
