3. BACKGROUND
• Important to understand, as different lesions
have significant patient management
implications
• Many cystic lesions of the pancreas are either
malignant or premalignant
• Pseudocysts, Serous Cystandomas, mucinous
cystic neoplasms, and IPMN’s account for
>90% for cystic lesions
4. • The morphology of a cystic
lesion varies greatly; the article
authors define 4 specific
subtypes:
• Unilocular
• Microcystic
• Macrocystic
• Cyst with Solid component
5.
6. ROLE OF CLINICAL HISTORY
• The majority of cystic lesions are asymptomatic and
incidentally discovered
• Patients who are symptomatic usually have abdominal pain.
• Jaundice or Recurrent Pancreatitis may suggest
communication/obstruction of the pancreatic/biliaryducts
• Pseudocysts are associated with acute/chronic pancreatitis.
7. UNILOCULAR CYST
• Simple cyst Features:
• No internal septations
• No Solid component
• No cyst wall calcification
• Most common Lesions:
• Pseudocyst
• IPMN
• Unilocular serous cystadenoma
• Lobulated lesion within
pancreatic head
• Lymphoepithelial cyst
• VHL
8. PSEUDOCYST
• Unilocular cyst with a
history of pancreatitis,
usually represents a
pseudocyst
• Internal debris is
highly specific
• No Solid component,
scar or wall
calcification
http://www.radiologyassistant.nl/en/p4c7bb77267de/pancreas-cystic-lesions.html
9. IPMN
Sidebranch and Main duct subtypes
Sidebranch:
Communicates with MPD
Main Duct
Diffuse or segmental dilatation of pancreatic duct
12. MICROCYSTIC LESION
• Serous cystadenoma
• Benign
• (70% )of serous cystadenomas are
polycystic or microcystic.
• “Honeycomb” or “sponge
appearance” (20%)
• External lobulation
• Hyperenhancement possible.
• 30% have a fibrous central scar,
with or without stellate
calcifications
• Note that there is also a
macrocystic/oligocystic variant
(<10%)
• >6 cysts which are <2 cm in
diameter
15. MUCINOUS CYSTADENOMA
• High malignant potential
• Can be asymptomatic or cause
obstructive symptoms
• Enhancement of thin internal
septa
• Peripheral eggshell
calcifications
• Highly predictive of
malignancy
• More common in tail, body
(>95%) of pancreas
• Can occasionally have an
enhancing unilocular
appearance
• Can be difficult to differentiate
from macrocystic form of serous
cystadenoma
17. MACROCYSTIC/OLIGOCYSTIC
SEROUS CYSTADENOMA
• Uni or bilocular
• Cysts may be >2 cm unlike microcystic adenoma
• NO peripheral wall Calcifications
• NO mural nodulesNO obstruction of pancreatic duct
• NO Capsule
• Lobulated
20. CYST WITH SOLID COMPONENT
• Can be unilocular or multiloculuar, and includes mucionous cystic neoplasms and
solid pancreatic neoplasms with a cystic component or cystic degeneration
• Solid Pseduopapillary tumor
• Adenocarcinoma
• Metastatic disease
• These tumors are either malignant or have high malignant potential, surgical
management.
• MR is more sensitive for detecting small mural nodules.
• Small nodules that may be missed on CT/US Can be seen on EUS
21.
22.
23. SOLID PSEDUOPAPILLARY
NEOPLASM (SPEN)
• Rare
• Found in 20-30 year old
Women
• 15% Malignant
• Encapsulated, with internal
necrosis, hemorrhage, cystic
change
• “hemangioma” like
enhancement
• Predilection for tail
24. PROBLEM SOLVING INDETERMINATE
LESIONS
• If the lesion has atypical features, most consider cystic degeneration of a malignant
mass (Neuroendocrine, Adenocarcinoma, METS, etc.)
• Cyst aspiration (Amylase, CEA, CA-19-9) Can be helpful
• MRI is a useful problem solving tool, CT is useful for calcification detection
• EUS can be very helpful
• Is the Patient Symptomatic?
• What is the size of the lesion? >3 CM?
25. SMALL PANCREATIC CYSTIC LESIONS
• International Consensus Guidelines for Management of Intraductal Papillary
Mucinous Neoplasms and Mucinous Cystic Neoplasms of the Pancreasby Masao
Tanaka et al
Pancreatology Volume 12, Issue 3 , Pages 183-197, May 2012
