Cystic Pancreatic Lesions


Serous Cystic Neoplasm

  1. Serous cystic adenomas contain multiple small cysts resulting in a lobulated contour. Some have a central scar with calcifications.

  2. Benign tumor, but large tumors have a tendency to increase in size and cause symptoms

  3. Typically seen after 60 years of age

  4. Microcystic or honey-combed cyst with central scar (30%) and calcifications (18%)

  5. Macrocystic in 10% and difficult to differentiate from pseudocyst and mucinous cystic neoplasm

  6. Lobulated surface

  7. No communication between cysts and pancreatic duct.

  8. Hypervascular enhancement is sometimes seen and can look like cystic neuroendocrine tumor

  9. Growth rate of tumors Growth rate of tumors > 4 cm: up to 20 mm/y

Mucinous Cystic Neoplasm

  1. Premalignant tumor - may transform into a Mucinous Cystadenocarcinoma

  2. Exclusively seen in women - Median age: 40-50 years

  3. Macrocystic with thick wall septations and peripheral calcifications

  4. Peripheral calcifications seen in 25%. This finding allows you to make a specific diagnosis

  5. Location in the tail and body of the pancreas (95%).

  6. Most are symptomatic, presenting with nondescript abdominal pain

Intraductal Papillary Mucinous Neoplasm

  1. Mucin producing tumor in main pancreatic duct or branch-duct.

  2. Location: pancreatic head >> tail and body.

  3. Must have communication with pancreatic duct. Best seen with MRCP.

  4. Can be multifocal.

  5. Main-duct IPMN has imaging features distinct from branch-type.

  6. Branch-duct type can look like other cystic neoplasms

Signs of malignancy are:

  1. Pancreatic duct > 8 mm - as in this case.

  2. Solid node in duct.

  3. Mass around the pancreatic duct.

  4. Enlarged choledochal duct.

Solid Pseudopapillary Neoplasm

  1. Very uncommon neoplasm seen in women 20-30 years.

  2. Solid and cystic neoplasm with capsule and with early 'hemangioma-like' enhancement. Sometimes intratumoral hemorrhage

Neuroendocrine tumor with cystic degeneration

  1. Non-functioning endocrine neoplasm

  2. Islet cell tumor

  3. Hypervascular with ring-enhancement. This is unlike serous cystic neoplasms that enhance from the center and more solid)