Congress:
RANZCR-AOCR 2012
Type:
Educational Exhibit
Keywords:
Cysts, Biopsy, Endoscopy, Ultrasound, MR, CT, Pancreas, Biliary Tract / Gallbladder, Abdomen
Authors:
A. AGARWAL, R. M. Mendelson; Perth/AU
Imaging Findings OR Procedure Details
METHODS:
- The radiologic information at Royal Perth Hospital was searched for the terms “pancreas” or “pancreatic” and “cyst” on CT abdomen or MRI reports between 1/08/2011 and 1/2/2012.
- Imaging findings were correlated with histopathology when available.
RESULTS:
- A total of 32 patients were identified with pancreatic cystic lesions on imaging.
- 12 had simple cysts (i.e no prior history of pancreatitis,
unilocular with smooth wall and no solid component) and
- 6 had pseudocysts (i.e prior history of pancreatitis)
- The remainder 14 had features consistent with cystic neoplasm of the pancreas,
10 had subsequent aspiration that concurred with the imaging findings in all except one.
DISCUSSION:
Cytic pancreatic lesions can be classified into:
- Unilocular cysts
- Microcystic
- Macrocystic
- Cysts with solid conponent
1.
Unilocular cysts—
- Pancreatic Pseudocyst and intra- ductal papillary mucinous neoplasm (IPMN)- most common
- Mucinous cystadenoma
- Others- oligocystic serous cystadenoma,
lymphoepithelial cyst,
and cystic islet cell neoplasm.
2.
Microcystic lesions—serous cystadenoma
3.
Macrocystic lesions (multilocular cysts with fewer compartments,
each > 2 cm)—
- Mucinous cystadenoma,
- IPMN,
and
- lymphoepithelial cyst.
4.
Cysts with solid components- mucinous cystic neoplasm (mucinous cystadenoma and mucinous cystadenocarcinoma), IPMN, solid and papillary epithelial neoplasm,
and solid neoplasms that may show cystic degeneration such as adenocarcinoma and islet cell tumors.
TRUE CYSTIC NEOPLASMS:
Most common are :
- Serous cystadenomas,
- Mucinous cystic neoplasms,
and
- Intraductal papillary mucinous neoplasms
Clinico-radiological course:
- Benign:pseudocysts and serous cystadenomas
- Malignant:
- high malignant potentialmucinous cystic neoplasms,main- duct IPMNs,
andsolid and papillary neoplasms
- Low malignant potential:Side branch IPMNs
1.
PSEUDOCYST:
- Any age
- M=F
- Unilocular or multilocular
- associated with pancreatitis
- located anywhere in the pancreas
2.
SEROUS CYSADENOMA:
- > 60, F
- microcystic
- Central scar with calcification
- smooth lobulated contour
- minimal wall enhancement
- commonly located in the pancreatic head
3.
MUCINOUS CYSTIC NEOPLASM:
- 50,
F
- Unilocular or multilocular
- septated cystic lesion
- surrounding ovarian type stroma
- Usually located in body and tail of pancreas
4.
INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM:
- 40,
- M>F
- communicate with pancreatic duct
- Subtypes:main pancreatic duct type,
isolated side branch type or a combination of both
5.
SOLID AND PAPILLARY EPITHELIAL NEOPLASM:
- 35,
F
- mixed cystic and solid components
- shows progressive accumulation of contrast agent
- usually located in the tail
MANAGEMENT ALGORITHM:
1.
Symptomatic cysts,
neoplasms with high malignant potential,
and lesions >3 cm in size :
- Endoscopic ultrasound with fine-needle aspiration
- Surgical referral
2.
For asymptomatic patients,
an algorithmic approach as oulined in Figure 26 may be adopted.