Serous Cystic Neoplasm
• Serous cystic adenomas contain multiple small cysts resulting in a lobulated contour. Some have a central scar with calcifications.
• Benign tumor, but large tumors have a tendency to increase in size and cause symptoms
• Typically seen after 60 years of age
• Microcystic or honey-combed cyst with central scar (30%) and calcifications (18%)
• Macrocystic in 10% and difficult to differentiate from pseudocyst and mucinous cystic neoplasm
• Lobulated surface
• No communication between cysts and pancreatic duct.
• Hypervascular enhancement is sometimes seen and can look like cystic neuroendocrine tumor
• Growth rate of tumors Growth rate of tumors > 4 cm: up to 20 mm/y
Mucinous Cystic Neoplasm
• Premalignant tumor - may transform into a Mucinous Cystadenocarcinoma
• Exclusively seen in women - Median age: 40-50 years
• Macrocystic with thick wall septations and peripheral calcifications
• Peripheral calcifications seen in 25%. This finding allows you to make a specific diagnosis
• Location in the tail and body of the pancreas (95%).
• Most are symptomatic, presenting with nondescript abdominal pain
Intraductal Papillary Mucinous Neoplasm
• Mucin producing tumor in main pancreatic duct or branch-duct.
• Location: pancreatic head >> tail and body.
• Must have communication with pancreatic duct. Best seen with MRCP.
• Can be multifocal.
• Main-duct IPMN has imaging features distinct from branch-type.
• Branch-duct type can look like other cystic neoplasms
Signs of malignancy are:
• Pancreatic duct > 8 mm - as in this case.
• Solid node in duct.
• Mass around the pancreatic duct.
• Enlarged choledochal duct.
Solid Pseudopapillary Neoplasm
• Very uncommon neoplasm seen in women 20-30 years.
• Solid and cystic neoplasm with capsule and with early 'hemangioma-like' enhancement. Sometimes intratumoral hemorrhage
Neuroendocrine tumor with cystic degeneration
• Non-functioning endocrine neoplasm
• Islet cell tumor
• Hypervascular with ring-enhancement. This is unlike serous cystic neoplasms that enhance from the center and more solid)