Pancrease cysy

1. PANCREATIC CYSTIC LESIONS
Rahaf Fattah

2. OVERVIEW
▸ Pancreatic cystic lesions CT vs MRI.
▸ Classification of pancreatic cystic lesions.
▸ Imaging, demographics and clinical features of pancreatic
cystic lesions.

3. CT
▸ Detectionofcysticlesion.
▸ Characterizationofcyst:
Location
Internalarchitecture
Enhancement
Ca++
MRI/MRCP
▸ Detailedcharacterization.
▸ Communicationwiththepancreaticduct.
▸ ExtentofMPDinvolvement
▸ Muralnodulesetc

4. MRI/MRCP

5. PANCREATIC CYSTIC LESION
NONNEOPLASTIC CYSTS NEOPLASTIC CYST
Pseudocyst
SOLIDTUMOR-CYSTIC
DEGENERATION
Serouscystadenoma
Mucinous cysticneoplasm
IPMN(pancreaticcancer)
Solidpapillaryepithelial
neoplasm

6. IMPORTANT POINTS !
Presentation
Patientage
Gender
Locationofthecysticlesion

7. PSEUDOCYST

8. PSEUDOCYST
▸ Most common cystic lesion
▸ Key clinical history:
Pancreatitis
Pancreatic trauma
‣ Cysts develop in 4-6 weeks

9. CT C+
AXIAL T2 FS AXIAL T1 C+
CORONAL T2

10. Pseudocyst SCA MCN IPMN SPEN
Prevalent age Variable Old Middle age Elderly Young
Sex M>F F>M
Female
30-50
M>F Female
Pancreatitis Yes No No
Not
uncommon
No
Location Evenly Evenly Body/Tail
Head/uncinate
process
Evenly
Malignant
potential
None Rare
Moderate-
high
Low to high Low
CLINICALANDDEMOGRAPHICFEATURES

11. SEROUS CYSTADENOMA (SCA)

12. SCA
▸ Grandmother lesion
▸ uncommon type of benign cystic pancreatic neoplasm.
▸ Three morphological patterns have been described 1:
• polycystic: 70%
• honeycomb: 20%
• oligocystic (macrocystic variant): <10%
• No communication between cysts and pancreatic duct

13. CT C+
CT C+
T2
FATSAT
T1 C+

14. CT C+
T2 MRCP

15. Pseudocyst SCA MCN IPMN SPEN
Prevalent age Variable Old Middle age Elderly Young
Sex M>F F>M
Female
30-50
M>F Female
Pancreatitis Yes No No
Not
uncommon
No
Location Evenly Evenly Body/Tail
Head/uncinate
process
Evenly
Malignant
potential
None Rare
Moderate-
high
Low to high Low
CLINICALANDDEMOGRAPHICFEATURES

16. MUCINOUS CYSTIC NEOPLASM
(MCN)

17. MCN
▸ Mother lesion
• Premalignant tumor - may transform into a mucinous cystadenocarcinoma.
• Exclusively seen in women - Typically in 'Mother' - median age: 40-50 years.
• Macrocystic with thick wall septations.
• Peripheral calci
fi
cations seen in 25%.
• Location in the tail and body of the pancreas (95%).

18. CT C+

19. T1 FS C+
T2

20. Pseudocyst SCA MCN IPMN SPEN
Prevalent age Variable Old Middle age Elderly Young
Sex M>F F>M Female M>F Female
Pancreatitis Yes No No
Not
uncommon
No
Location Evenly Evenly Body/Tail
Head/uncinate
process
Evenly
Malignant
potential
None Rare
Moderate-
high
Low to high Low
CLINICALANDDEMOGRAPHICFEATURES

21. INTRADUCTAL PAPILLARY
MUCINOUS NEOPLASM (IPMN)

22. IPMN
▸ Grandfather lesion.
Divided macroscopically:
• main duct
• branch duct type
• mixed-type lesions

23. CORONALMIP
CT C+

24. MRCP
T1 C+

25. SIGNSOFMALIGNANCYARE:
• Pancreatic duct > 8mm .
• Solid node in duct.
• Mass around the pancreatic duct.
• Enlarged choledochal duct.
CORONALMIP
CT C+

26. Pseudocyst SCA MCN IPMN SPEN
Prevalent age Variable Old Middle age Elderly Young
Sex M>F F>M
Female
30-50
M>F Female
Pancreatitis Yes No No
Not
uncommon
No
Location Evenly Evenly Body/Tail
Head/uncinate
process
Evenly
Malignant
potential
None Rare
Moderate-
high
Low to high Low
CLINICALANDDEMOGRAPHICFEATURES

27. SOLID PSEUDOPAPILLARY
EPITHELIAL NEOPLASM (SPEN)

28. SPEN
▸ Daughter lesion.
▸ Rare and usually benign.
▸ Solid and cystic components owing to
hemorrhagic degeneration.

29. CTC+ T2 FS
T1 FS

30. CTC+

31. Pseudocyst SCA MCN IPMN SPEN
Prevalent age Variable Old Middle age Elderly Young
Sex M>F F>M
Female
30-50
M>F Female
Pancreatitis Yes No No
Not
uncommon
No
Location Evenly Evenly Body/Tail
Head/uncinate
process
Evenly
Malignant
potential
None Rare
Moderate-
high
Low to high Low
CLINICALANDDEMOGRAPHICFEATURES

32. REFERENCES
▸ https://pubs.rsna.org/doi/full/10.1148/rg.210056
▸ https://pubs.rsna.org/doi/abs/10.1148/rg.256045161?journalCode=radiographics
▸ https://radiologyassistant.nl/abdomen/pancreas/pancreas-cystic-lesions

33. THANK YOU.