Learning objectives
Identify benign vs. malignant pancreatic cysts and risk factors
Identify salient imaging findings in cystic pancreatic tumors that will aid in diagnosis and characterization
Review of a radiologist’s role in guiding management and guidelines for management based on imaging findings.
Background
There are over 20 documented sub-types of pancreatic cysts, ranging from benign to malignant. They may form secondary to inflammatory insults (i.e. pancreatitis) or may represent primary tumors. The practicing radiologist must have the skills necessary to distinguish benign cystic lesions from potentially deadly cystic neoplasms on imaging studies. Knowledge of characteristic imaging findings and relevant patient history are essential in the diagnosis of these lesions. Accurate diagnosis via imaging is critical in guiding future steps in management and predicting patient prognosis. The purpose of...
Findings and procedure details
I. Pathologic Classification of Cystic Lesions (Fig. 2)
Injury/Inflammatory related cysts
Pseudocysts and walled off necrosis
Neoplastic Cysts
Serous cystadenoma/neoplasm (SCN)
Mucin-producing lesions
- Mucinous cystic neoplasm (MCN)
- Intraductal papillary mucinous neoplasm (IPMN)
Ductal adenocarcinoma with cystic features
Endocrine Lineage
Cystic neuroendocrine tumors
Acinar Lineage
Acinar lineage cystadenocarcinoma
Undetermined Lineage
Solid pseudopapillary neoplasm (SPN)
Other Miscellaneous
Lymphoepithelial cysts
Squamoid cyst of pancreatic ducts
Epidermoid cysts within the intrapancreatic accesory spleen
Abscess
Intraductal tubular carcinoma
II. Characterization
MR is the modality of choice as it...
Conclusion
Cystic tumors of the pancreas may represent any one of a variety of benign or malignant entities.
Radiologists should be aware of imaging findings and clinical characteristics that are worrisome for malignant disease.
Our presentation aims to identify characteristic imaging features of the above mentioned cystic tumors of the pancreas and to reinforce the Radiologist’s crucial role in the diagnosis and management of these entities.
Personal information and conflict of interest
N. Venugopal; Augusta/US - nothing to disclose N. Kinger; Atlanta, GA/US - nothing to disclose C. Moreno; Atlanta/US - nothing to disclose M. Roda; Jackson, MS/US - nothing to disclose F. H. Miller; Chicago, IL/US - nothing to disclose P. Mittal; Decatur, GA/US - nothing to disclose
References
Bordeianou L, Vagefi PA, Sahani D, et al. Cystic pancreatic endocrine neoplasms: a distinct tumor type? J Am Coll Surg 2008;206:1154–1158.
Figueiras R, Martin C, et al. The Spectrum of Cystic Masses of the Pancreas: Imaging Features and Diagnostic Difficulties. Current Problems in Diag Radio 2007; 36: 199-212
Kalb B, Sarmiento JM, Kooby DA et-al. MR imaging of cystic lesions of the pancreas. Radiographics. 2009;29 (6): 1749-65
Kim YH, Saini S, Sahani D, Hahn PF, Mueller PR, Auh YH. Imaging diagnosis of cystic pancreatic lesions:...