Which type of pancreatic cystadenoma arises from the ducts and has malignant potential, often presenting as multiloculated lesions that may have irregular margins or displace the CBD and pancreatic duct?

• A. Macrocystic
• B. Microcystic
• C. Serous cystadenoma
• D. Mucinous cystadenoma

Answer: (A)

Pancreatic cystic neoplasms differ by origin, appearance, and malignant potential, and the description in this item points to a mucinous neoplasm with large, multi-chambered cysts. A macrocystic mucinous cystadenoma is characterized by sizable cystic spaces (few large locules) that can appear multiloculated on imaging. These lesions arise from mucinous epithelium and carry a significant risk of malignant transformation, which explains why they’re described as having malignant potential. Their mass effect can distort nearby structures, leading to displacement of the common bile duct and the pancreatic duct, and the irregular margins can reflect internal septations and wall thickening associated with these neoplasms.

This helps explain why the macrocystic variant is the best fit: it aligns with having malignant potential and presenting as multiloculated cystic lesions with possible duct displacement, unlike serous cystadenomas, which are typically microcystic and benign, and thus lack malignant potential.