Learning objectives
Provide an overview of main clinical and radiological features of common pancreatic cystic neoplasms;
Discuss the appropriate management of pancreatic cystic neoplasms based on current international guidelines;
Report cases from our hospital,
with radiologic-pathologic correlation.
Background
Nowadays pancreatic cysts are common incidental findings due to advance and widespread useof imaging modalities.
Many of these lesions are non-neoplastic,
mostly pseudocysts.
However,
an important proportion are neoplastic: some can have an indolent course while others can be malignant or have malignant potential.
Several guidelines have been developed and uploaded in order to provide a practical approach of pancreatic cystic lesions; there are similarities between them,
but also some differences and controversies.
The key to a successfully management is a careful combination of clinical,...
Findings and procedure details
CASE REPORT 1
- Female,
73 years old.
- Clinical information:Incidentalomas found in the study of chronic liver disease.
Diagnosis:Mixed typeintraductal papillary mucinous neoplasm.
Indication for surgery:Relative.
CASE REPORT 2
- Male,
78 years old
- Clinical information:Incidentaloma on CT,
by surveillanceofascending aortic aneurysm.
Diagnosis:Branch duct intraductal papillary mucinous neoplasm.
Indication for surgery:Relative.
CASE REPORT 3
- Female,
81 years old,
caucasian
- Clinical information: Asymptomatic; Incidental pancreatic lesion.
Diagnosis:Serous Cystic Neoplasm.
Indication for surgery:No.
CASE REPORT 4
- Female,
34 years old,
caucasian
-...
Conclusion
Radiologists should be able to recognize and risk stratify pancreatic cystic neoplasms to improve diagnosis and surveillance of these lesions.
A multidisciplinary approach is crucial,
based on guidelines and clinical sense,
and management must be adjusted to patient context.
References
• European Study Group on Cystic Tumours of the Pancreas.
European evidence-based guidelines on pancreatic cystic neoplasms.
Gut.
2018 May;67(5):789-804.
• Takaori K,
et al.
International Association of Pancreatology (IAP)/European Pancreatic Club (EPC) consensus review of guidelines for the treatment of pancreatic cancer.
Pancreatology.
2016 Jan-Feb;16(1):14-27.
• Tanaka M,
et al: Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas.
Pancreatology 2017; 17: 738–753.
• Vege SS,
et al.; Clinical Guidelines Committee; American Gastroenterology Association.
American gastroenterological association institute guideline...