Edit concept Question Editor Create issue ticket

Cystadenoma

Cystadenomas

A cystadenoma is a benign growth of glandular tissue that forms a cyst and is filled with secretions. Although cystadenomas are benign, they may cause problems by compressing neighboring tissues. The three major forms are serous, mucinous and papillary cystadenomas. The different forms have varying tendencies for malignant transformation.


Presentation

Cystadenomas can be found in many tissues, often with a preponderance of one of the three forms (serous, mucinous or papillary). The article below concentrates on cystadenomas of the pancreas, liver, and ovaries. However, a short literature search will discover many other tissues that harbor cystadenomas: among others, the lungs, the appendix, the mesorectum, the epididymis, the spermatic cord, the endometrium, and the parotid gland (papillary cystadenoma of the parotid gland is called Warthin’s tumor).

Most cysts observed in the pancreas are pseudocysts associated with pancreatitis. Cystadenomas are mainly of two kinds: serous and mucinous (called mucinous cystic neoplasm); both occur more frequently in women than men. Intraductal papillary mucinous tumor (IPMT) is a recently recognized category of the latter class. Whereas serous cystadenomas in the pancreas are almost always benign, mucinous cystic neoplasm (MCN) and IPMT can turn malignant - about a third of MCN cases that are resected can be associated with malignant tissue [1]. Patients may present with nausea and abdominal pain, but with the increased use and improvements in radiologic imaging technologies, many cystic lesions are discovered incidentally [2].

Cysts in the liver are quite common: they occur in 5-10% of the population; however, most of them are simple hepatic cysts. Hepatic (biliary) cystadenomas are much rarer. Biliary cystadenomas are serous and mucinous, with the overwhelming majority belonging to the latter category. Although benign, biliary cystadenomas have a strong tendency to recur, and a high potential for malignant progression. Both cystadenomas and cystadenocarcinomas grow slowly, like simple hepatic cysts. Their presentation – abdominal pain, nausea, and vomiting – is also similar. Many cysts are discovered when imaging is performed for unrelated reasons [3].

Ovaries may contain a variety of cysts, most of them formed as a result of the normal functioning of the ovaries during the menstrual cycle, such as follicular cysts and corpus luteal cysts. Abnormal growth may lead to the formation of cystadenomas, both serous and mucinous. Serous cystadenomas are the most frequently occurring epithelial ovarian tumors. Mucinous cystadenomas are usually large and multilocular and may have a tendency to grow very large. They may, occasionally, induce excessive accumulation of mucinous material in the abdominal cavity, a potentially lethal condition. Most patients with cystadenomas do not experience symptoms; thus, cysts are often discovered at routine check-ups. However, sometimes symptoms do appear: the most general being abdominal cramps and discomfort. Severe pain may accompany ovarian torsion, caused by the cysts.

Familial Adenomatous Polyposis
  • Familial adenomatous polyposis (FAP) may be associated with some extracolonic manifestations which in this vein, it is known as Gardner's syndrome. To our knowledge, so far, there is no report of mucinous cystadenoma in association with FAP.[ncbi.nlm.nih.gov]
  • adenomatous polyposis pancreas Insulinoma Glucagonoma Gastrinoma VIPoma Somatostatinoma Cholangiocarcinoma Klatskin tumor Hepatocellular adenoma / Hepatocellular carcinoma Urogenital Renal cell carcinoma Endometrioid tumor Renal oncocytoma Endocrine[en.wikipedia.org]
  • adenomatous polyposis. ( 28247059 ) Fatemi S.R....Mohsenifar Z. 2017 50 Primary retroperitoneal mucinous cystadenoma. ( 28858738 ) Nardi W.S....Quildrian S.D. 2017[malacards.org]
Abdominal Cramps
  • However, sometimes symptoms do appear: the most general being abdominal cramps and discomfort. Severe pain may accompany ovarian torsion, caused by the cysts.[symptoma.com]
Parotid Mass
  • An 82 year-old woman with right parotideal mass had an operation of superficial parotidectomy.[ncbi.nlm.nih.gov]
Breast Mass
  • Volume 12, Issue 2 Sonoelastographic Strain Index for Differentiation of Benign and Malignant Nonpalpable Breast Masses Nariya Cho, Woo Kyung Moon, Ha Young Kim et al.[jultrasoundmed.org]
Scrotal Mass
  • It usually presents with a unilateral scrotal mass, clinically and radiologically indistinguishable from malignant testicular tumors. We report a 39-year-old man who presented with a right testicular mass.[ncbi.nlm.nih.gov]
Primary Amenorrhea
  • We report a case of bilateral Sertoli cell adenoma in gonads with unilateral serous cystadenoma, in an elderly phenotypic woman with primary amenorrhea. We also provide radiological and pathological studies.[ncbi.nlm.nih.gov]
Testicular Mass
  • We report a 39-year-old man who presented with a right testicular mass. The patient underwent radical inguinal orchiectomy. Grossly, no masses were appreciated.[ncbi.nlm.nih.gov]

Workup

Distinguishing serous and mucinous cystic lesions of the pancreas is of critical importance because mucinous cystic neoplasm has an almost 20% risk of turning malignant [1]. Serous cystadenoma of the pancreas is made up of many small cysts and usually has a grapelike or honeycomb appearance, but a small proportion of cases have oligocystic or macrocystic presentations [4], which are difficult to distinguish from mucinous cystic neoplasm. A central scar, calcification, and lack of connection with the pancreatic duct are also generally characteristic of serous cystadenoma. Mucinous cystic neoplasm has a round shape and is surrounded by ovary-like stroma. Carcinoembryonic antigen levels, which are increased inside mucinous type cystadenomas, can be determined to help distinguish mucinous cysts from macrocystic serous cystadenomas [1]. Distinction from pancreatic pseudocysts can be made clinically, based on the occurrence of pancreatitis. Adenocarcinoma is distinguished from cysts by its solid appearance. Ultrasonography and computed tomography (CT) are used to describe and characterize the cysts; however, endoscopic ultrasound and fine needle aspiration may be needed to verify the diagnosis [5].

Biliary cystadenomas are not easy to distinguish clinically from simple cysts or cystadenocarcinomas, therefore imaging and laboratory results are crucial. Both ultrasound and CT can distinguish cystadenomas from simple cysts. However, imaging may not be able to differentiate between cystadenomas and cystadenocarcinomas: both appear as an anechoic mass with echogenic internal septations. Ultrasound images do not show convincing differences between cystadenomas and cystadenocarcinomas regarding their sizes, shapes, or locations [6]. Laboratory tests show normal liver function values, although in some cases the levels of enzymes and bilirubin may be higher. Analysis of cyst fluid can show elevated tumor marker CA19-9 and tumor-associated glycoprotein 72 levels; the latter may differentiate between simple cysts and cystadenomas [7].

Ultrasonography is the initial examination that a patient suspected of having an ovarian cyst should undergo [8]. Both endovaginal and transabdominal ultrasound can be employed; sonography should yield a good morphological description. Examination by CT and magnetic resonance imaging may provide additional information. Simple ovarian cysts are rarely malignant; many patients diagnosed with ovarian cysts can be managed conservatively. In postmenopausal women with small ovarian cysts, the risk of cancer is extremely small [9]. Combined results of ultrasonography and measurements of carcinoma antigen 125 are useful for following up patients with small cysts.

Right Pleural Effusion
  • Possible findings include coarse curvilinear calcifications in the right upper abdominal quadrant and elevation of the right hemidiaphragm, if hepatomegaly or right pleural effusion is present.[emedicine.com]
Normocytic Anemia
  • The patient had elevated erythrocyte sedimentation rate (ESR), increased C-reactive protein (CRP) and normocytic anemia.[ncbi.nlm.nih.gov]
Ischemic Changes
  • No ischemic changes occurred in the bowel. The presence of several well-developed collateral vessels was shown by 3-dimensional computed tomography examination. The patient had an uneventful postoperative period and was discharged.[ncbi.nlm.nih.gov]

Treatment

  • CONCLUSION: The only possible treatment of cystadenomas is their radical surgical removal. Any other incomplete surgical treatment is insufficient and associated with a high risk of malignant transformation.[ncbi.nlm.nih.gov]
  • Treatment of Benign Mucinous Cystadenoma of Ovary Treatment of benign mucinous cystadenoma of ovary mainly depends on the size of the tumor and the associated symptoms, if any.[epainassist.com]
  • The patient was a 37-year-old woman referred to our hospital with a painless mass on the left upper lip initially found during treatment at a local dental clinic. The medical history was non-contributory.[ncbi.nlm.nih.gov]
  • Surgical resection should be chosen as an optimal treatment.[ncbi.nlm.nih.gov]
  • Similar to prostate cystadenomas, en bloc excision is the optimal treatment. [Indexed for MEDLINE] Free full text[ncbi.nlm.nih.gov]

Prognosis

  • Long-term prognosis is good in the case of a benign tumor.[ncbi.nlm.nih.gov]
  • We summarized our experience with the diagnosis, clinicopathologic feature, treatment and prognosis of ACA to provide a reference for the disposal of this uncommon condition.[ncbi.nlm.nih.gov]
  • Treatment and prognosis A mucinous cystadenoma is benign with excellent prognosis (c.f. borderline mucinous tumors of the ovary or mucinous cystadenocarcinoma of the ovary).[radiopaedia.org]
  • Clear cell cystadenoma: Clear cell cystadenoma is a benign cyst with an excellent prognosis. Complications Cystadenomas of the ovary are benign lesions that rarely recur after incomplete resection.[statpearls.com]
  • A medical professional can provide a likely prognosis and work with a patient to determine the best course of treatment.[knowcancer.com]

Etiology

  • A 78-year-old woman presented to the urology clinic with a large, symptomatic left-sided abdominal cyst that was believed to be renal in etiology for many years and that had been percutaneously drained 3 times previously with persistent regrowth.[ncbi.nlm.nih.gov]
  • Etiology The etiology of hepatic cystadenomas is unknown. The resemblance of embryonic structures, such as the gallbladder and the biliary tree, originating from the foregut suggests that these lesions arise from ectopic remnants.[emedicine.medscape.com]
  • Etiology Thought to largely derive from ovarian epithelial inclusions, which itself is derived from fallopian tube epithelium. Location They can be bilateral in 15% of cases.[radiopaedia.org]

Epidemiology

  • Terminology Also called papillary cystadenofibroma Epidemiology Second most common benign neoplasm of epididymis after adenomatoid tumor Sporadic or familial Unilateral or bilateral (40%) Mean age 36 years Associated with von Hippel-Lindau (VHL) disease[pathologyoutlines.com]
  • Their histological, epidemiological and semiological characteristics are now better known. However, their natural history remains poorly understood affecting therapeutic management as well.[internationalpancreatology.org]
  • Seromucinous cystadenoma: According to some authors, seromucinous cystadenomas likely derive from endometriosis. [5] Epidemiology Serous cystadenoma: Benign serous tumors of the ovary represent 16% of all ovarian epithelial neoplasms and account for two-thirds[statpearls.com]
  • Epidemiology United States data The prevalence of hepatic cystadenomas is low, with fewer than 200 cases reported in the literature. These tumors account for a very small number of all hepatic tumors.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • This article reviews pathophysiology, prevalence, CT features, mimickers and recommendations for management of pancreatic serous cystadenoma. Copyright 2016 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.[ncbi.nlm.nih.gov]
  • Collision Tumor: Diagnostic, Treatment Considerations, and Review of the Literature. ( 30326307 ) Snyder R...Mason RB 2019 3 Detailed assessment of hypothalamic damage in craniopharyngioma patients with obesity. ( 30181653 ) Fjalldal S...Erfurth EM 2019 4 Pathophysiology[malacards.org]
  • References 1 Klinge U, Prescher A, Klosterhalfen B and Schumpelick V: Development and pathophysiology of abdominal wall defects. Chirurg. 68:293–303. 1997.(In German).[spandidos-publications.com]
  • Pathophysiology Hepatic cystadenomas appear as multilocular (rarely unilocular) cystic lesions that are surrounded by a smooth and thick fibrous capsule.[emedicine.medscape.com]

Prevention

  • Although the origin of ACA is still contradictory, surgery is actively advocated as the most effective method for relieving the symptoms and preventing the tumor from local extension or malignant transformation so as to obtain an optimal long-term survival[ncbi.nlm.nih.gov]
  • Mucinous Cystadenoma Prevention and Treatment Mucinous Cystadenoma usually do not shrink by themselves they may remain as non- interfering in some cases. Smaller sized cystadenomas can be removed by laparoscopic method.[mucinous.org]
  • Complete surgical resection of cystic masses in the mesentery is recommended to confirm the diagnosis and prevent recurrence.[insurancenewsnet.com]
  • […] of surgical complications, because we use disposable and qualitative tools Good tolerance to surgery because we practice only the noninvasive techniques Excellent cosmetic effect, because we impose intradermal sutures that don’t even need to remove Prevention[allcysts.com]
  • Cystadenomas require complete excision to prevent recurrence and the possibility of malignant transformation. Cystadenocarcinomas are very rare. Despite complete resection, cystadenocarcinomas can recur in a short period of time.[ncbi.nlm.nih.gov]

References

Article

  1. Farrell JJ. Prevalence, Diagnosis and Management of Pancreatic Cystic Neoplasms: Current Status and Future Directions. Gut Liver. 2015 Sep 23;9(5):571-589.
  2. Kadiyala V, Lee LS. Endosonography in the diagnosis and management of pancreatic cysts. World J Gastrointest Endosc. 2015 Mar 16;7(3):213-223.
  3. Nakagawa M, Matsuda M, Masaji H, Goro W. Successful preoperative diagnosis of biliary cystadenoma with mesenchymal stroma and its characteristic imaging features: report of two cases. Turk J Gastroenterol. 2011;22:631–635.
  4. Tseng JF, Warshaw AL, Sahani DV, Lauwers GY, Rattner DW, Fernandez-del Castillo C. Serous cystadenoma of the pancreas: tumor growth rates and recommendations for treatment. Ann Surg. 2005 Sep;242(3):413-419.
  5. Gerke H, Silva R, Jensen CS. Hypervascular pancreatic tumor diagnosed as a serous cystadenoma by EUS-guided Trucut biopsy. Gastrointest Endosc. 2006;64:273-274.
  6. Xu HX, Lu MD, Liu LN. Imaging features of intrahepatic biliary cystadenoma and cystadenocarcinoma on B-mode and contrast-enhanced ultrasound. Ultraschall Med. 2012 Dec; 33 (7): E241-249.
  7. Fuks D, Voitot H, Paradis V, et al. Intracystic concentrations of tumour markers for the diagnosis of cystic liver lesions. Br J Surg. 2014 Mar;101(4):408-416.
  8. Osmers R. Sonographic evaluation of ovarian masses and its therapeutical implications. Ultrasound Obstet Gynecol. 1996 Oct;8(4):217-222.
  9. Bailey CL, Ueland FR, Land GL, et al. The malignant potential of small cystic ovarian tumors in women over 50 years of age. Gynecol Oncol. 1998 Apr;69(1):3-7.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2019-07-11 22:30