1
|
NAZLI MA, BARUT AY, KILIÇKESMEZ Ö. The Role of Tissue Harmonic Ultrasonography and Computerized Tomography in the Diagnosis of Intraabdominal Cystic Lesions. İSTANBUL GELIŞIM ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2021. [DOI: 10.38079/igusabder.964865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
2
|
Yadav RK, Jiang X, Chen J. Differentiating benign from malignant pancreatic cysts on computed tomography. Eur J Radiol Open 2020; 7:100278. [PMID: 33163586 PMCID: PMC7607418 DOI: 10.1016/j.ejro.2020.100278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/11/2020] [Accepted: 09/23/2020] [Indexed: 12/19/2022] Open
Abstract
CT can distinguish between benign and premalignant or malignant pancreatic cysts. Solid component and septation were the only CT features that could differentiate benign from malignant cysts. Cyst wall enhancements on CT were more commonly observed in premalignant or malignant cysts than in benign cysts. CT is a necessary diagnostic modality to preoperatively detect and characterize pancreatic lesions.
Purpose It is important to identify features on computed tomography (CT) that can distinguish between benign and premalignant or malignant pancreatic cysts to avoid unnecessary surgeries. This study investigated the preoperative diagnostic evaluation of cystic pancreatic lesions to determine how advanced imaging and clinical factors should guide management. Methods In total, 53 patients with 27 benign and 26 premalignant or malignant cysts were enrolled. CT features of the cysts were compared using univariate and multivariate analyses. Results On univariate analysis, a solid component (p < 0.01), septation (p < 0.01), location (p < 0.01), border (p < 0.01), wall enhancement (p = 0.01), lesion margins (p < 0.01), pancreatic atrophy (p = 0.04), and a cystic wall (p < 0.01) were all significantly different between benign and premalignant or malignant cysts. On multivariate analysis, only a solid component (p < 0.01) and septation (p < 0.01) were significant. Conclusion A thin cystic wall, uniform homogeneity, a clear border, the presence of septation, pancreatic atrophy, and the absence of both wall enhancements and solid components were more frequently seen in benign cysts. A thick wall, lack of homogeneity, the presence of wall enhancements and solid components, absence of septation, only a small degree of pancreatic atrophy, and unclear borders were more frequent among premalignant or malignant cysts. The only CT features to differentiate benign from premalignant or malignant cysts were a solid component and septation.
Collapse
Key Words
- CEA, Carcinoembryonic antigen
- CPR, Curved planar reformation
- CTA, CT angiography
- DWI, Diffusion-weighted imaging
- ERCP, Endoscopic retrograde cholangiopancreatography
- FDG PET, Fluorodeoxyglucose PET
- FNA, Fine-needle aspiration
- HASTE, Half-Fourier acquisition single-shot turbo spin-echo
- IPMN, Intraductal papillary mucinous neoplasia
- MCA, Mucinous cystadenoma
- MCB, Mucinous cystic borderline tumor
- MCC, Mucinous cystadenocarcinoma
- MCN, Mucinous cystic neoplasm
- MPD, Main pancreatic duct
- MPR, Multi-planar reformation
- MRA, MR angiography
- MRCP, MR cholangiopancreatography
- MRI, Magnetic resonance imaging
- MSCT, Multi-slice helical computed tomography
- PACS, Picture archiving and communicating system
- PCN, Cystic neoplasms of the pancreas
- PDAC, Pancreatic ductal adenocarcinoma
- PET, Positron emission computed tomography
- Pancreatic cystic lesions
- Pancreatic ductal adenocarcinoma
- Pancreatic neoplasm
- ROI, Region of interest
- SCA, Serous cystadenoma
- SMA, Serous microcystic adenoma
- US, Ultrasonography
Collapse
Affiliation(s)
- Rajesh Kumar Yadav
- Second Affiliated Hospital, Department of Radiology, Sun Yat-sen University, Guangzhou 510000, China
- Corresponding author: Current Address: Novus Health Wellness, 4808 Munson St NW, OH 44718 USA.
| | - Xinhua Jiang
- Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Jianyu Chen
- Second Affiliated Hospital, Department of Radiology, Sun Yat-sen University, Guangzhou 510000, China
| |
Collapse
|
3
|
Berevoescu N, Scăunașu R, Berevoescu M, Croitoru A. Mucinous cystadenoma of the pancreas associated with pregnancy. Case report and review of the literature. JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2018. [DOI: 10.25083/2559.5555/3.2/88.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective. We present a rare pathology with uncommon onset. Background. Mucinous cystic pancreatic neoplasms (MCNs) are rare tumors, which generally occur in the fifth and sixth decades of women. Although some tumours are frankly malignant, all are in fact considered to be potentially malignant. Case report. We present the case of a 30-year-old patient, with a 16/11 cm tumor located in the pancreas body, which was diagnosed 8 months after birth. The preoperative assessment of the pancreatic lesion suggested the diagnosis of mucosal cyst neoplasm, without being able to determine its benign or malignant nature. Central pancreatectomy was performed with a good postoperative evolution. Histopathologic result was represented by mucinous pancreatic chistadenoma. Two years after surgical intervention, the patient presented no signs of recurrence or pancreatic (exocrine or endocrine) secretion deficiency. Conclusions. Preoperative imaging evaluation could be suggestive for mucinous cystic tumour, but this cannot specify however the nature of the tumor. The postpartum occurrence could establish a possible relationship between hormonal levels encountered during pregnancy and the development of this tumor, taking into considerations the ovarian-type stroma and the presence of hormone (estrogen and progesterone) receptors in this neoplasm. Central pancreatectomy without anastomosis preserves the functions of pancreas, and also decreases morbidity.
Collapse
|
4
|
Abstract
A variety of pancreatic and peripancreatic neoplasms may contain calcifications. We present a review of common to uncommon pancreatic neoplasms that may contain calcifications to include ductal adenocarcinoma, pancreatic neuroendocrine tumors, serous cystadenomas, solid pseudopapillary tumors, intraductal papillary mucinous neoplasms, mucinous cystic neoplasms, and lymphoepithelial cysts. In addition, duodenal mucinous adenocarcinoma can present as a peripancreatic mass that may contain calcification. Knowledge of the spectrum of calcification patterns can help the interpreting radiologist provide a meaningful differential.
Collapse
|
5
|
ZHANG BEIBEI, GUO XIAORONG, ZHANG JINGXI, LIU XIAO, ZHAN XIANBAO, LI ZHAOSHEN. MicroRNA-224 is downregulated in mucinous cystic neoplasms of the pancreas and may regulate tumorigenesis by targeting Jagged1. Mol Med Rep 2014; 10:3303-9. [DOI: 10.3892/mmr.2014.2658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 06/09/2014] [Indexed: 11/06/2022] Open
|
6
|
Bai XL, Zhang Q, Masood N, Masood W, Zhang Y, Liang TB. Pancreatic cystic neoplasms: a review of preoperative diagnosis and management. J Zhejiang Univ Sci B 2013; 14:185-94. [PMID: 23463761 DOI: 10.1631/jzus.b1200283] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Pancreatic cystic neoplasms (PCNs) are a diverse group of neoplasms in the pancreas, and are more increasingly encountered with widespread abdominal screening and improved imaging techniques. The most common types of PCNs are serous cystic neoplasms (SCNs), mucinous cystic neoplasms (MCNs), and intraductal papillary mucinous neoplasms (IPMNs). Clinicians frequently feel bewildered in the differential diagnosis and subsequent management among the various types of lesions in the pancreas, which may lead to overtreatment or delayed treatment. The current review provides recent developments in the understanding of the three most common types of PCNs, the latest modalities used in preoperative diagnosis and differential diagnosis, as well as the most up to date management. Suggestions for diagnosis and differential diagnosis of SCNs, MCNs, and IPMNs are also provided for young surgeons. Better understanding of these neoplasms is essential for clinicians to make accurate diagnosis and to provide the best management for patients.
Collapse
Affiliation(s)
- Xue-li Bai
- Department of Hepatobiliary-Pancreatic Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | | | | | | | | | | |
Collapse
|
7
|
Metachronous malignant composite phaeochromocytoma and pancreatic mucinous cystadenoma in a patient with neurofibromatosis type 1. Pathology 2011; 43:170-4. [DOI: 10.1097/pat.0b013e32834274a3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
8
|
Fatima Z, Ichikawa T, Motosugi U, Muhi A, Sano K, Sou H, Haradome H, Kiryu S, Araki T. Magnetic resonance diffusion-weighted imaging in the characterization of pancreatic mucinous cystic lesions. Clin Radiol 2011; 66:108-11. [DOI: 10.1016/j.crad.2010.10.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 10/15/2010] [Accepted: 10/17/2010] [Indexed: 10/18/2022]
|
9
|
Morel A, Marteau V, Chambon E, Gayet B, Zins M. Pancreatic mucinous cystadenoma communicating with the main pancreatic duct on MRI. Br J Radiol 2010; 82:e243-5. [PMID: 19934064 DOI: 10.1259/bjr/98185084] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
We report a case of a mucinous cystadenoma of the pancreas communicating with the main pancreatic duct. To our knowledge, this is the first case in which a communication between the mucinous cystadenoma and the main pancreatic duct could be demonstrated by MRI.
Collapse
Affiliation(s)
- A Morel
- Department of Radiology, Saint Joseph Hospital, Paris, France.
| | | | | | | | | |
Collapse
|
10
|
Yoon SE, Byun JH, Kim KA, Kim HJ, Lee SS, Jang SJ, Jang YJ, Lee MG. Pancreatic ductal adenocarcinoma with intratumoral cystic lesions on MRI: correlation with histopathological findings. Br J Radiol 2009; 83:318-26. [PMID: 19620175 DOI: 10.1259/bjr/69770140] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The purpose of this study was to evaluate intratumoral cystic lesions of pancreatic ductal adenocarcinoma (PDAC) depicted on MRI, and to correlate these cystic lesions with their histopathological findings. This study included 12 patients (7 males and 5 females; mean age, 59 years) with intratumoral cystic lesions of PDAC detected on a retrospective MRI review. We reviewed the histopathological findings of the cystic lesions within PDACs and analysed the MRI findings, focusing on the appearance of the intratumoral cystic lesions, i.e. the size, number, margin and intratumoral location, and on the ancillary findings of PDAC, i.e. peripancreatic infiltration, upstream pancreatic duct dilatation and distal parenchymal atrophy. Intratumoral cystic lesions were classified as neoplastic mucin cysts (n = 7, 58%) or cystic necrosis (n = 5, 42%) according to the histopathological findings; they ranged in greatest dimension from 0.5 cm to 3.4 cm (mean, 1.7 cm). Seven patients had only one cystic lesion each, while the remaining five had multiple cystic lesions. Most of the neoplastic mucin cysts had smooth margins (n = 6, 86%) and eccentric locations (n = 6), whereas most cystic necroses had irregular margins (n = 4, 80%) and centric locations (n = 4). The most common ancillary findings of PDAC were peripancreatic infiltration, distal pancreatic atrophy and upstream pancreatic duct dilatation (92%, 75% and 58%, respectively). The intratumoral cystic lesions of PDACs on MRI were classified as either neoplastic mucin cysts with smooth margins and eccentric locations or cystic necroses with irregular margins and centric locations.
Collapse
Affiliation(s)
- S E Yoon
- Departments of Radiology, University of Ulsan College of Medicine,Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736, Korea
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Matsuno YK, Saito T, Gotoh M, Narimatsu H, Kameyama A. Supported Molecular Matrix Electrophoresis: A New Tool for Characterization of Glycoproteins. Anal Chem 2009; 81:3816-23. [DOI: 10.1021/ac900157c] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Yu-ki Matsuno
- Research Center for Medical Glycoscience, National Institute of Advanced Industrial Science and Technology (AIST), Open Space Laboratory C-2, 1-1-1 Umezono, Tsukuba, Ibaraki 305-8568, Japan, and Department of Surgery I, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Takuro Saito
- Research Center for Medical Glycoscience, National Institute of Advanced Industrial Science and Technology (AIST), Open Space Laboratory C-2, 1-1-1 Umezono, Tsukuba, Ibaraki 305-8568, Japan, and Department of Surgery I, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Mitsukazu Gotoh
- Research Center for Medical Glycoscience, National Institute of Advanced Industrial Science and Technology (AIST), Open Space Laboratory C-2, 1-1-1 Umezono, Tsukuba, Ibaraki 305-8568, Japan, and Department of Surgery I, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Hisashi Narimatsu
- Research Center for Medical Glycoscience, National Institute of Advanced Industrial Science and Technology (AIST), Open Space Laboratory C-2, 1-1-1 Umezono, Tsukuba, Ibaraki 305-8568, Japan, and Department of Surgery I, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Akihiko Kameyama
- Research Center for Medical Glycoscience, National Institute of Advanced Industrial Science and Technology (AIST), Open Space Laboratory C-2, 1-1-1 Umezono, Tsukuba, Ibaraki 305-8568, Japan, and Department of Surgery I, Fukushima Medical University, Fukushima 960-1295, Japan
| |
Collapse
|
12
|
Petrone MC, Arcidiacono PG. Role of endosocopic ultrasound in the diagnosis of cystic tumours of the pancreas. Dig Liver Dis 2008; 40:847-53. [PMID: 18499542 DOI: 10.1016/j.dld.2008.03.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Accepted: 03/31/2008] [Indexed: 12/11/2022]
Abstract
With the increased use of sophisticated imaging, cystic lesions in the pancreas are being recognized with greater frequency. Although imaging alone may not provide a specific diagnosis in many cases, a combination of imaging characteristics, clinical presentation, and additional procedures such as endoscopic ultrasound guided fine needle aspiration of cystic lesion, allows appropriate management. Cystic lesions in the pancreas can be divided pathologically into congenital cysts, pseudocysts and cystic neoplasm. At least four different types of cystic neoplasm have been described: mucinous neoplasms, intraductal papillary mucinous neoplasms, serous neoplasms and papillary cystic neoplasms The most important diagnosis is differentiating between mucinous and non-mucinous cystic lesion because of their different potential of malignancy. Endoscopic ultrasound provides the highest resolution of the pancreas and endoscopic ultrasound-fine needle aspiration can supply further diagnostic information on the basis of cytology, fluid viscosity, concentration of tumour glycoproteins, amylase level, molecular analysis that may contribute to the better clinical outcome of these neoplasms.
Collapse
Affiliation(s)
- M C Petrone
- Gastroenterology Department, IRCCS San Raffaele Hospital, Vita e Salute University, Milan, Italy.
| | | |
Collapse
|
13
|
Visser BC, Muthusamy VR, Yeh BM, Coakley FV, Way LW. Diagnostic evaluation of cystic pancreatic lesions. HPB (Oxford) 2008; 10:63-9. [PMID: 18695762 PMCID: PMC2504857 DOI: 10.1080/13651820701883155] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cystic pancreatic neoplasms (CPNs) present a unique challenge in preoperative diagnosis. We investigated the accuracy of diagnostic methods for CPN. MATERIAL AND METHODS This retrospective cases series includes 70 patients who underwent surgery at a university hospital for presumed CPNs between 1997 and 2003, and for whom a definitive diagnosis was established. Variables examined included symptoms, preoperative work-up (including endoscopic retrograde cholangiopancreatography (ERCP) in 22 cases and endoscopic ultrasound (EUS) in 12), and operative and pathological findings. Preoperative computed tomography (CT) and magnetic resonance imaging (MRI) scans (n=50 patients; CT=48; MRI=13) were independently reviewed by two blinded GI radiologists. RESULTS The final histopathologic diagnoses were mucinous cystic neoplasm (n=13), mucinous cystadenocarcinoma (10), serous cystadenoma (11), IPMN (14), simple cyst (3), cystic neuroendocrine tumor (5), pseudocyst (4), and other (10). Overall, 25 of 70 were malignant (37%), 21 premalignant (30%), and 24 benign (34%). The attending surgeon's preoperative diagnosis was correct in 31% of cases, incorrect in 29%, non-specific "cystic tumor" in 27%, and "pseudocyst vs. neoplasm" in 11%. Eight had been previously managed as pseudocysts, and 3 pseudocysts were excised as presumed CPN. In review of the CT and MRI, a multivariate analysis of the morphologic features did not identify predictors of specific pathologic diagnoses. Both radiologists were accurate with their preferred (no. 1) diagnosis in <50% of cases. MRI demonstrated no additional utility beyond CT. CONCLUSIONS The diagnosis of CPN remains challenging. Cross-sectional imaging methods do not reliably give an accurate preoperative diagnosis. Surgeons should continue to err on the side of resection.
Collapse
Affiliation(s)
- B. C. Visser
- Departments of Surgery, University of CaliforniaSan Francisco CAUSA
| | - V. R. Muthusamy
- Gastroenterology, University of CaliforniaSan Francisco CAUSA
| | - B. M. Yeh
- Radiology, University of CaliforniaSan Francisco CAUSA
| | - F. V. Coakley
- Radiology, University of CaliforniaSan Francisco CAUSA
| | - L. W. Way
- Departments of Surgery, University of CaliforniaSan Francisco CAUSA
| |
Collapse
|
14
|
García Figueiras R, Villalba Martín C, García Figueiras A, Otero Echart M, Requejo Isidro I, Pazos González G, Rosario A. The Spectrum of Cystic Masses of the Pancreas: Imaging Features and Diagnostic Difficulties. Curr Probl Diagn Radiol 2007; 36:199-212. [PMID: 17765799 DOI: 10.1067/j.cpradiol.2007.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Cystic masses of the pancreas comprise a diverse group of pathologic entities ranging from pseudocysts to cystic tumors. Although their presentations may be similar, the appropriate treatment and patient management can differ greatly. There is an overlap in radiologic features, but the clinical context and some imaging findings are useful in differentiating among these entities; the differential diagnosis could be considerably reduced and it is generally possible to reach the correct diagnosis. In this article, we review imaging characteristics and radiologic patterns of both common and uncommon cystic masses of the pancreas. An algorithmic approach for the management of cystic pancreatic lesions is proposed.
Collapse
Affiliation(s)
- Roberto García Figueiras
- Department of Radiology, Complexo Hospitalario Universitario de Santiago (CHUS), Santiago de Compostela 15706, Spain.
| | | | | | | | | | | | | |
Collapse
|
15
|
Abstract
This article presents the approach to the most commonly encountered pancreatic cystic masses that the authors employ at the University of Pittsburgh Medical Center. Variations on this approach are to be expected, based on several factors, including the availability of sophisticated imaging equipment and personnel.
Collapse
Affiliation(s)
- Michael P Federle
- Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite 3950, Pittsburgh, PA 15213, USA.
| | | |
Collapse
|
16
|
Goh BKP, Tan YM, Cheow PC, Chung YFA, Chow PKH, Wong WK, Ooi LLPJ. Cystic neoplasms of the pancreas with mucin-production. Eur J Surg Oncol 2005; 31:282-7. [PMID: 15780564 DOI: 10.1016/j.ejso.2004.12.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2004] [Indexed: 01/29/2023] Open
Abstract
AIM To compare the clinico-pathological features of intraductal papillary mucinous cystic tumours (IPMT) and mucinous cystic tumours (MCT) of the pancreas. METHODS Eighteen patients with IPMT and 18 with MCT who underwent surgical resection between 1990 and 2004 were retrospectively reviewed. Their clinico-pathological features were compared using univariate analysis. Statistical analyses of potential predictive factors of malignancy for each of these two groups were also conducted. RESULTS Patients with IPMT were found to be older (64+/-10 vs 43+/-18 years, p<0.001) and were predominantly male (male:female ratio, 5:4 vs 1:17, p=0.003) as compared to patients with MCT. MCTs were found in the body-tail region (100%) whereas IPMTs were more evenly distributed (50% in the head) (p=0.001). Pathologically, IPMT was distinct from MCT in terms of size (3.8+/-3.2 vs 9.1+/-4.4 cm, p=0.001), association with secondary pancreatitis (50 vs 0%, p=0.011), communication with the pancreatic duct (94 vs 0%, p<0.001), presence of a dilated main pancreatic duct (61 vs 0%, p<0.001) and the presence of ovarian-type stroma (0 vs 44%, p=0.003). CONCLUSION IPMT and MCT are distinct clinico-pathological entities. This distinction is important as management and outcome of these entities may differ.
Collapse
Affiliation(s)
- B K P Goh
- Department of Surgery, Singapore General Hospital, Outram Road, Singapore 169608.
| | | | | | | | | | | | | |
Collapse
|
17
|
Levy MJ, Clain JE. Evaluation and management of cystic pancreatic tumors: emphasis on the role of EUS FNA. Clin Gastroenterol Hepatol 2004; 2:639-53. [PMID: 15290655 DOI: 10.1016/s1542-3565(04)00235-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cystic lesions of the pancreas are increasingly recognized and usually represent pseudocysts or cystic pancreatic tumors (CPTs), but also include congenital cysts, acquired cysts, extrapancreatic cysts, or cystic degeneration of solid tumors. It is important to distinguish CPT lesions given their varied prognosis and therapy. Mucinous varieties of CPTs (mucinous cystic neoplasms and intraductal papillary mucinous tumors) are premalignant or malignant, and surgical resection is generally recommended in good operative candidates. In contrast, nonmucinous CPTs include serous cystadenomas with a very low malignant potential, or pseudocysts, which are always benign. As a result, nonmucinous CPTs are generally resected only when inducing symptoms or complications. Review of the clinical, imaging, laboratory, and pathology information may clarify the specific tumor type. The relatively limited accuracy of any one modality requires that we consider the combined results when making management decisions.
Collapse
MESH Headings
- Biopsy, Fine-Needle
- Endosonography
- Female
- Histocytological Preparation Techniques
- Humans
- Male
- Middle Aged
- Neoplasms, Cystic, Mucinous, and Serous/diagnostic imaging
- Neoplasms, Cystic, Mucinous, and Serous/pathology
- Neoplasms, Cystic, Mucinous, and Serous/therapy
- Pancreatic Neoplasms/diagnostic imaging
- Pancreatic Neoplasms/pathology
- Pancreatic Neoplasms/therapy
- Pancreatic Pseudocyst/diagnostic imaging
- Pancreatic Pseudocyst/pathology
- Pancreatic Pseudocyst/therapy
Collapse
Affiliation(s)
- Michael J Levy
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
| | | |
Collapse
|
18
|
Abstract
Cystic pancreatic neoplasms are being diagnosed with growing frequency due to improving imaging technologies and increasing clinician awareness. Distinguishing cystic neoplasms from pseudocysts and discriminating among the various cystic neoplasms is essential to appropriate management. The backbone of diagnosis of these tumors continues to be cross-sectional imaging by CT and MRI. Despite refinements in technology and significant progress in characterizing these lesions, the overall accuracy of CT and MR is limited. EUS, especially as means of FNA, will have an increasing role in the evaluation of selected cases as experience grows. No radiologic investigation can reliably distinguish cystic neoplasms from pseudocysts nor differentiate among cystic neoplasms in all cases. For uncertain lesions, surgeons should favor either careful observation with serial imaging or surgical resection.
Collapse
Affiliation(s)
- Brendan C Visser
- Department of Surgery, University of California-San Francisco, 513 Parnassus Avenue, Room S-343, San Francisco, CA 94143-0470, USA.
| | | | | | | |
Collapse
|
19
|
Abstract
Although the majority of cystic lesions of the pancreas seen in clinical practice represent postinflammatory pseudocysts, it is important for the radiologist to be knowledgeable of the wide spectrum of cystic masses of the pancreas and the variable prognoses they possess. As a result of similarities in the imaging features of these lesions, a definitive diagnosis is often not possible. By combining imaging features with clinical history, a reasonable differential diagnosis can be offered to the referring physician. In some cases, biopsy or fluid aspiration may be required prior to surgery. In a patient without the appropriate history of pancreatitis and the presence of a cystic pancreatic mass, it is incumbent upon the radiologist to offer alternative diagnoses of cystic neoplasms of the pancreas.
Collapse
Affiliation(s)
- Nancy Hammond
- Department of Radiology, Northwestern University, The Feinberg School of Medicine, 676 North St. Clair, Suite 800, Northwestern Memorial Hospital, Chicago, IL 60611, USA
| | | | | | | |
Collapse
|
20
|
Demos TC, Posniak HV, Harmath C, Olson MC, Aranha G. Cystic lesions of the pancreas. AJR Am J Roentgenol 2002; 179:1375-88. [PMID: 12438020 DOI: 10.2214/ajr.179.6.1791375] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Terrence C Demos
- Department of Radiology, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL 60153, USA
| | | | | | | | | |
Collapse
|
21
|
Affiliation(s)
- Fergus V Coakley
- Department of Radiology, Abnormal Imaging, University of California-San Francisco Medical Center, California 94122, USA
| | | |
Collapse
|
22
|
Mortelé KJ. Mucinous cystic tumors. AJR Am J Roentgenol 2001; 177:1217. [PMID: 11641211 DOI: 10.2214/ajr.177.5.1771217a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|