Cystic lymphangioma of the pancreas

Adult Primary Retroperitoneal Lymphangioma: Updated Facts

Lymphangioma is a rare, benign tumor of the lymphatic system. It is believed to be a congenital malformation, when part of the lymphatic channels fail to connect to the main lymphatic system. Lymphangioma is a tumor of the pediatric age, with 50% of patients presenting at birth. The head and neck are the main affected sites (75%), while the retroperitoneal cavity is the least affected area, and comprises less than 1% of cases. Adult lymphangioma is an extremely rare tumor, and adult retroperitoneal lymphangioma (ARL) is even a rarer tumor. Over the last two decades, we have experienced a significant increase in reports published in the English literature discussing ARL. As reports have increased, several questions about previously known facts regarding this tumor arose: For years, it was known that ARL is usually an asymptomatic tumor which is incidentally found - is it a true claim? Is abdominal magnetic resonance imaging the radiological test of choice for diagnosis? What is the best therapeutic option? The main aim for this article is to review the current and old English literature concerning ARL, in order to collect data regarding demographic features, clinical presentation, imaging tests used for diagnosis, therapeutic options and follow-up. This in turn will give precise updated answers for the previous questions. In addition, it will raise awareness for the treating physician regarding the most effective approach for early diagnosis and best therapeutic option to be selected.

Case report and literature review: Giant retroperitoneal cystic lymphangioma

Background

Cystic lymphangioma is a rare benign tumor of the lymphatic system, which is most commonly observed in the neck, head and armpit.Less than 5% of lymphangiomas occur in the abdominal cavity and even less in the retroperitoneum.

Case description

A 65-year-old male patient was diagnosed with an "abdominal mass that had persisted for 1 year, accompanied by abdominal pain, abdominal distension and dyspnea for 7 days". After abdominal computerd tomography, a giant multilobed abdominal lymphangioma was suspected, which squeezed the intestinal canal and was closely related to the inferior vena cava. The patient underwent an exploratory laparotomy, during which, it was found that the tumor formed extensive adhesions to the transverse colon, small intestine and pelvic wall, and enveloped the abdominal aorta, superior mesenteric artery, inferior mesenteric artery and inferior vena cava to varying degrees. It was diffcult to remove the cyst completely. Postoperative pathology confirmed the diagnosis of retroperitoneal cystic lymphangioma. The patient recovered well after the operation, was eating normally by 5 days postoperatively,and was discharged 10 days postoperatively.The patient was followed up 1 month after postoperatively and no evidence of recurrence was observed.

Conclusion

In this case, we report a patient with giant retroperitoneal cystic lymphangioma who underwent exploratory laparotomy combined with preoperative abdominal computerd tomography and acute abdominal pain, abdominal distension and dyspnea. Because of the large volume of the tumor and its close relationship with the superior mesenteric artery and other blood vessels, the surgeon used scissors to separate the tumor sharply and removed the whole tumor completely.

Pancreatic Lymphangioma: An Unusual Cause of Abdominal Lump

Lymphangiomas are uncommon benign malformations that can occur anywhere in the body. These are hamartomatous malformations with lymphatic differentiation, which uncommonly involve the abdomen and rarely the pancreas.

The size of the cysts in pancreatic lymphangioma directly correlates with the clinical manifestations; however, most of them are non-specific. Preoperative diagnosis is challenging because conventional imaging examinations like an abdominal ultrasonogram (USG), computed tomography, or magnetic resonance imaging cannot distinguish pseudocyst, mucinous cyst neoplasms, simple cyst, intraductal papillary mucinous neoplasms, and serous cystadenoma.

We are presenting a rare case of pancreatic lymphangioma where the definitive diagnosis was made postoperatively in histopathological examination. A female patient aged 27 years presented to the Surgery outpatient department with a slow-growing abdominal lump of 9 months duration. Clinical examination revealed large, non-tender, soft cystic swelling occupying the entire upper abdomen. Radiological imaging showed a large multiseptated cystic lesion occupying almost the entire abdomen and adhered to the pancreas with mass effect. USG-guided fine-needle aspiration revealed straw-colored aspirate with mature lymphocytes.

On exploration, there was a large multiloculated cyst occupying the whole abdomen. Cysts were decompressed, and the entire lesion was excised. Final histopathological examination showed unremarkable pancreatic tissue with attached lesion consisting of dilated lymphatic spaces with lymphatic follicles.

MRI of mucinous pancreatic cystic lesions: a new updated morphological approach for the differential diagnosis

Pancreatic cystic lesions (PCLs) have been increasingly identified over the past 2 decades due to the widespread use of high-resolution non-invasive abdominal imaging. They cover a vast spectrum, from benign to malignant and invasive lesions, thus they constitute a significant clinical entity. Among PCLs, mucin-producing lesions are those at risk of progression to malignancy. They include mucinous cystic neoplasms (MCN) and intraductal papillary mucinous neoplasms (IPMN). The diagnosis and management of these cystic lesions are a dilemma since there is a significant overlap in the morphology of benign and premalignant lesions. At the moment, there is no single test that will allow a correct diagnosis in all cases. Magnetic resonance (MR) and endoscopic ultrasound (EUS) morphology, with cyst fluid analysis and cytohistology done with EUS-guided procedure are the best techniques that can narrow the differential diagnosis and identify potentially malignant lesions requiring resection from those requiring follow-up only. The purpose of this paper is to present an updated review of MR imaging findings of mucinous PCLs and to provide a new morphological approach that can serve as a practical guide for the diagnosis of these lesions, allowing a more confident characterization and avoiding relevant misdiagnosis. Furthermore, we provide some information about EUS and cystic fluid analysis and cytohistology, since they are diagnostic modalities that radiologists and surgeons should be familiar with.

Lymphangioma of the Small Intestine Case Report and Review of the Literature

Lymphangioma usually occurs in children and usually involves the skin. Mesenteric lymphangiomas are extremely rare in adults (1,2,3). Lymphangioma of the small-bowel mesentery is rare, representing less than 1% of all lymphangiomas (4).

We report a case of a 62-year-old female who presented with abdominal pain, discomfort, nausea and vomiting. Pre-operative tests including abdominal ultrasonography and magnetic resonance imaging were performed, but they could not accurately determine the nature of the tumour. Laparotomy was performed; the tumour was excised completely, and a large cystic tumour of the small bowel mesentery was found. Histopathological examination diagnosed the tumour as a cystic lymphangioma. Lymphangiomas are extremely rare, especially in the abdomen of adults, and are asymptomatic for the most part; they often present as acute abdominal conditions, causing life-threatening complications such as secondary infection, rupture with haemorrhage, and volvulus or intestinal obstruction when the tumour increases in size, requiring emergent surgery. Lymphangioma is often difficult to diagnose, and surgical resection is selected in many cases for both diagnosis and treatment.

Cystic lymphangioma of the pancreas: a hard diagnostic challenge between pancreatic cystic lesions-review of recent literature

Lymphangiomas are rare congenital benign tumors arising from the lymphatic system. The incidence of this disease in the pancreas is extremely rare, accounting for less than 1% of these tumors. Before introducing the review we reported a case of a 67-year-old woman with cystic lymphangioma of the pancreas. We reported the radiological investigations carried out preoperatively and the treatment performed. The review tries to identify the features described in literature of the pancreatic lymphangioma. We have performed a PubMed research of the world literature between January 1^st 2000, to November 31^st 2017, using the keywords [Lymphangioma pancreas], [diagnosis], [CT lymphangioma] and [MRI lymphangioma]. We have found 158 articles, of which about 100 were case reports. Based on our search criteria, we have identified 31 pancreatic lymphangioma in literature reporting their imaging characteristics. According to our report and to several authors in literature the diagnosis of cystic pancreatic lymphangioma should be considered as a differential diagnosis of pancreatic cystic lesions (PCLs). The role of imaging exams (CT and MRI) can help to identify and suspect this possibility of diagnosis. The endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) can have a potential role to reach the correct diagnosis.

Pancreatic Lymphangioma: A Case Report and Literature Review

We report a case of a 29-year-old woman with a pancreatic lymphangioma who presented clinically as a case of acute pancreatitis. Lymphangiomas are benign tumors of vascular origin with lymphatic differentiation, most commonly found in the head and neck. Pancreatic lymphangiomas are extremely rare, accounting for only 1% of abdominal lymphangiomas, with approximately 60 cases reported in the literature. Although imaging findings are characteristic and can point to the diagnosis, confirmation with fine needle aspiration and histopathologic correlation is necessary. Although these lesions are benign, they can often present a diagnostic dilemma and can be mistaken for other cystic pancreatic lesions, namely, pseudocysts, cysts, cystadenomas, and cystadenocarcinomas.

Giant Ovarian Lymphangioma: Case Report and Review of the Literature

INTRODUCTION

Lymphangiomas are benign tumors/malformations, characterized by proliferation of the lymphatic vessels. They may arise anywhere, although the most common localizations are the head-neck region and the axilla. To date, only 21 cases of lymphangioma of the ovary in a 60-year literature survey have been reported.

CASE REPORT

A 16-year-old female patient with long standing abdominal distension had 40 cm × 15 cm × 29 cm ovarian lymphangioma.

CONCLUSIONS

Our case highlights that lymphangiomas can occur in the adolescent population and should be added to the differential diagnosis of ovarian masses in this age group.

Invisible fat on CT: making it visible by MRI

Presence of fat in a lesion significantly narrows the differential diagnosis. Small quantities of macroscopic fat and intracellular fat are invisible on computed tomography (CT) and ultrasonography. Magnetic resonance imaging (MRI) can reveal any fatty change in a lesion and can also differentiate macroscopic fat from intracellular and intravoxel fat. Hypodensity on CT may be a sign of invisible fat and MRI can help to diagnose even minute amounts of fat in liver, pancreas, adrenal, musculoskeletal, and omental pseudolesions and lesions. This article will review the superiority of MRI over CT in demonstrating fat in abdominal lesions.

Laparoscopic excision of a large retroperitoneal lymphovascular malformation in an adult

Retroperitoneal lymphangioma is a rare benign tumour of the retroperitoneal lymphatics that usually manifests in infancy. It is worth reporting of an unexpected presentation, especially in an adult. They frequently affect the neck (75%) and the axilla (20%). Intra-abdominal lymphangiomas (<5%) have been reported in the mesentery, gastrointestinal tract, spleen, liver and pancreas. Retroperitoneal lymphangiomas account for nearly 1% of all lymphangiomas and are uncommon incidental findings usually at surgery, autopsy or lymphography. Differentiating cystic lymphangiomas from other cystic growths by imaging studies alone is often inconclusive, and surgery is frequently required for definitive diagnosis. An interesting and rare case of a retroperitoneal lymphangioma in an adult patient which was removed laparoscopically is described here.

Pancreatic Lymphangioma as a Rare Pancreatic Mass: A Case Report

Introduction

Cystic lymphangiomas of abdomen has mostly involved mesentery and retro peritoneum that should be considered as a differential diagnosis of abdominal masses. Pancreatic lymphangiomas were extremely rare that should be differentiated from neoplastic pancreatic cysts. Patients have commonly presented with epigastric pain and a relevant palpable epigastric mass.

Case Presentation

A 65-year-old lady who has presented with epigastric pain, then during investigations, a cystic tumor which located in the tail of pancreas, has found. Whereas definite diagnosis of tumor with routine procedures was impossible, the tumor has completely resected by distal pancreatectomy and splenectomy. Pathology and IHC was suggestive of benign lymphangioma.

Conclusions

According to this presentation diagnosis of cystic lymphangioma of the tail of pancreas should be considered as a differential diagnosis of pancreatic cystic lesions and complete excision has been the treatment of choice.

Cystic Lymphangioma of Pancreas

Lymphangiomas are benign hamartomatous malformations which can arise either from congenitally sequestered lymphatic channels or due to acquired obstruction caused by fibrosis of lymph channels. They are common in the pediatric age group in the soft tissue of neck and the axilla. Abdominal lymphangiomas are rare; even rarer is the primary involvement of pancreas. It occurs more frequently in females and is often located in the distal pancreas. The authors report the case of cystic lymphangioma of pancreas in a 26-year old female presenting with recurrent episodes of upper abdominal pain that was treated with laparoscopic cyst excision. Although exceptionally rare, lymphangioma of the pancreas should be considered in the differential diagnosis of pancreatic cystic lesions, especially in young women.

Rare nonneoplastic cysts of pancreas

Pancreatic cysts represent a small proportion of pancreatic diseases, but their incidence has been recently increasing. Most pancreatic cysts are identified incidentally, causing a dilemma for both clinicians and patients. In contrast to ductal adenocarcinoma, neoplastic pancreatic cysts may be cured by resection. In general, pancreatic cysts are classified as neoplastic or non-neoplastic cysts. The predominant types of neoplastic cysts include intraductal papillary mucinous neoplasms, mucinous cystic neoplasms, serous cystic neoplasms, and solid pseudopapillary neoplasms. With the exception of serous type, neoplastic cysts, have malignant potential, and in most cases requires resection. Non-neoplastic cysts include pseudocyst, retention cyst, benign epithelial cysts, lymphoepithelial cysts, squamous lined cysts (dermoid cyst and epidermal cyst in intrapancreatic accessory spleen), mucinous nonneoplastic cysts, and lymphangiomas. The incidence of nonneoplastic, noninflammatory cysts is about 6.3% of all pancreatic cysts. Despite the use of high-resolution imaging technologies and cytologic tissue acquisition with endosonography, distinguishing nonneoplastic from neoplastic cysts remains difficult with most differentiations made postoperatively. Nonetheless, the definitive distinction between non-neoplastic and neoplastic cysts is crucial as unnecessary surgery could be avoided with proper diagnosis. Therefore, consideration of these rare disease entities should be entertained before deciding on surgery.

Imaging of pediatric pancreatic neoplasms with radiologic-histopathologic correlation

OBJECTIVE

The purpose of this article is to describe the imaging features of pediatric pancreatic tumors with pathologic correlation. Epithelial and nonepithelial lesions are described. Pancreatic imaging protocols, clinical presentation, and management are also detailed.

CONCLUSION

Pancreatic neoplasms are rare in children and vary widely between benign and malignant causes and between cystic and solid lesions. Epithelial tumors are most common and include solid pseudopapillary tumor, pancreatoblastoma, islet cell neoplasms, and cystic lesions.

Lymphangioma: surrounding the ovarian vein and ovary

Lymphangiomas are usually benign lesions seen in the head and neck region in children. Intra-abdominal localisation is rare and the majority of these cases are in early childhood. Retroperitoneal lymphangiomas constitute approximately 1% of all lymphangiomas. They are generally diagnosed incidentally, may be asymptomatic or may present with a palpable abdominal mass. A limited number of cases of ovarian lymphangiomas have been reported in women, whereas there are no reported cases of paraovarian localisation. We present a rare case of lymphangioma located in bilateral paraovarian region and along the left ovarian vein with radiological findings.

Cystic tumors of the pancreas: imaging and management

Cystic tumors of the pancreas are a subset of rare pancreatic tumors that vary from benign to malignant. Many have specific imaging findings that allow them to be differentiated from each other. This article (1) reviews the imaging features of the common cystic pancreatic lesions, including serous microcystic adenoma, mucinous cystic tumor, intraductal papillary mucinous tumor, and solid pseudopapillary tumor, and including the less common lesions such as cystic endocrine tumors, cystic metastases, cystic teratomas, and lymphangiomas; and (2) provides comprehensive algorithms on how to manage the individual lesions, with recommendations on when to reimage patients.

Cystic lymphangioma of the pancreas mimicking pancreatic pseudocyst

Lymphangiomas are rare congenital benign tumors arising from the lymphatic system, and are mostly encountered in the neck and axillary regions of pediatric patients (95%). Lymphangioma of the pancreas is extremely rare accounting for less than 1% of these tumors. We report here on a case of pancreatic cystic lymphangioma. A 54-year-old woman presented with intermittent postprandial abdominal discomfort and radiating back pain. Abdominal computed tomography scan revealed 8 × 6.5 cm hypodense cystic mass arising from the tail of the pancreas without septa or solid component. The initial impression was a pancreatic pseudocyst. The patient underwent distal pancreatectomy with splenectomy. The histopathologic and immunohistochemical study helped make the diagnosis of a pancreatic cystic lymphangioma. Herein, we report a case of pancreatic cystic lymphangioma mimicking pancreatic pseudocyst and review the relevant medical literature.

Cystic lymphangioma of the pancreas with congenital intrahepatic duct dilatation and choledochal cyst

Cystic lymphangioma of the pancreas is an extremely rare benign tumor of lymphatic origin. We report on a 68-year-old woman who had experienced epigastric abdominal distension and nausea for over 1 year. Sonography revealed a cystic-solid mixed mass in the head of pancreas, with intrahepatic and extrahepatic duct dilatation. A diagnosis of cystic lymphangioma with congenital intrahepatic duct dilatation and choledochal cyst was made after excision and pathologic examination. Preoperative diagnosis of cystic lymphangioma of the pancreas is difficult, and carefulsonographic evaluation is required.

Retroperitoneal cystic lymphangioma in an adult: A case report and review of the literature

Lymphangiomas are rare benign cystic tumors of the lymphatic system. Retroperitoneal lymphangiomas account for 1% of all lymphangiomas, and approximately 186 cases have been reported. They may clinically present as a palpable abdominal mass and can cause diagnostic dilemmas with other retroperitoneal cystic tumors, including those arising from the liver, kidney and pancreas. This report describes the rare case of a cystic retroperitoneal lymphangioma in a 54-year-old male patient. The lymphangioma had progressed to the point of inducing clinical symptoms of abdominal distention, abdominal pain, anorexia, fever, nausea and diarrhea. Radiological imaging revealed a large multiloculated cystic abdominal mass with enhancing septations involving the upper retroperitoneum and extending into the pelvis. Surgical removal of the cyst was accomplished without incident. A benign cystic retroperitoneal lymphangioma was diagnosed on histology and confirmed with immunohistochemical stains.

Benign mesenteric lymphangioma presenting as acute pancreatitis: a case report

Benign mesenteric lymphangiomas are rare intra-abdominal cysts which may be asymptomatic or present with a variety of abdominal symptoms including an acute abdomen. We are however not aware of any reports in the literature linking mesenteric lymphangioma to acute pancreatitis. We present the case of a 62-year-old man who was admitted with signs and symptoms of acute pancreatitis and a palpable abdominal mass. Computerised tomography (CT) of his abdomen confirmed the presence of a mesenteric cystic mass. He underwent a laparotomy at which a large thin walled mass filled with a chylous fluid was resected. Histological analysis of this cyst showed it to be a benign mesenteric lymphangioma.

An unusual presentation of pancreatic pseudocyst mimicking cystic neoplasm of the pancreas: a case report

In spite of their rarity, cystic neoplasms of the pancreas are characterized by existing or potential malignancy that cannot be ignored during decisive process with regard to the choice of treatment. Diagnostic difficulties in the differentiation of pancreatic pseudocyst and cystic pancreatic neoplasm can lead to misdiagnosis and inappropriate treatment, since clinical symptoms, preoperative imaging tests and even endoscopic retrograde cholangiopancreatography are often not sufficient to establish the correct diagnosis. We present a case of pancreatic cyst with no typical features of pseudocyst in the medical interview, treated by Child's subtotal pancreatectomy by reason of the high risk of neoplasia suggested by radiological and endoscopic examinations.

Cystic lymphangioma of the pancreas

Lymphangioma of the pancreas is an extremely rare benign tumour of lymphatic origin, with fewer than 60 published cases. Histologically, it is polycystic, with the cysts separated by thin septa and lined with endothelial cells. Though congenital, it can affect all age groups, and occurs more frequently in females. Patients usually present with epigastric pain and an associated palpable mass. Complete excision is curative, even though, depending on the tumour location, surgery may be simple or involve extensive pancreatic resection and anastomoses. The authors present a 49-year-old woman in whom a polycystic septated mass, 35 mm x 35 mm in size, was discovered by ultrasonography (US) in the body of the pancreas during investigations for epigastric pain and nausea. At surgery, a well circumscribed polycystic tumor was completely excised, with preservation of the pancreatic duct. The postoperative recovery was uneventful. Histology confirmed a microcystic lymphangioma of the pancreas. Immunohistochemistry showed cystic endothelial cells reactivity to factor VIII-RA (++), CD31 (+++) and CD34 (-). Postoperatively, abdominal pain disappeared and the patient remained symptomfree for 12 mo until now. Although extremely rare, lymphangioma of the pancreas should be taken into consideration as a differential diagnosis of a pancreatic cystic lesion, especially in women.

Cystic tumors of the pancreas: ultrasound, computed tomography, and magnetic resonance imaging features

Cystic tumors of the pancreas are a subset of rare pancreatic tumors that vary from benign to malignant. Many have specific imaging findings that allow them to be differentiated from each other. This article aims to review the histopathologic and imaging findings of the relatively common lesions (serous microcystic adenoma, mucinous cystic tumor, intraductal papillary mucinous tumor, and solid pseudopapillary tumor) and uncommon lesions (cystic endocrine tumors, cystic metastases, cystic teratomas, and lymphangiomas) in this group.

Multilocular cystadenoma and cystadenocarcinoma of the prostate

BACKGROUND

Multicystic prostatic tumors are rare, with only a few reported cases of prostatic cystadenoma and cystadenocarcinoma in the scientific literature.

METHODS

A retrospective review of our tumor registry over the last 25 years identified 2 rare cystic tumors of the prostate: 1 multilocular cystadenoma and 1 multilocular cystadenocarcinoma.

RESULTS

The first case illustrates the clinical and pathologic features of prostatic multilocular cystadenoma. A 42-year-old man presented with a 16-cm suprapubic mass causing displacement of adjacent visceral organs. Pathologic examination after prostatectomy confirmed it to be a multilocular cystadenoma of the prostate. The patient's postoperative course was uneventful, and his serum prostate-specific antigen level remained at < or =0.04 ng/ml throughout the course of his disease. In the second case, we present an 80-year-old male presenting with a 12-cm cystic mass of the prostate. His serum prostate-specific antigen level remained at > or =9.0 ng/ml throughout the course of his disease. The tumor had an aggressive local growth pattern, with invasion into perirectal adipose tissue. This patient underwent a pelvic exenteration, followed by adjuvant systemic chemotherapy and complete androgen blockade. Despite aggressive treatment, he had 3 recurrences over 4 months but remains alive with disease at 23-month follow-up.

CONCLUSIONS

Cystadenocarcinoma of the prostate is locally aggressive and should be included in the differential diagnosis of cystic lesions of the prostate.

Differential diagnosis of cystic lymphangioma of the pancreas based on imaging features

Lymphangioma is a benign tumor, which is a consequence of lymphatic malformation with blockage of lymphatic flow. Most lymphangiomas occur in the neck and axillary region, and < 1% occur in the mesentery or retroperitoneum. Lymphangiomas arising from the pancreas are extremely rare. We report the case of a 34-year-old woman with cystic lymphangioma of the pancreas without major symptoms or signs. A 6 x 6 cm intra-abdominal cystic mass was incidentally revealed by sonography during a health examination. It is always a challenge to differentiate the lesion from other possible cystic-like pancreatic neoplasms. Differential diagnosis of cystic lymphangioma from other cystic-like tumors of the pancreas can be performed based on their imaging characteristics, including presence of septa, cystic or wall calcification, soft tissue, wall thickness, single or multiple loculation, and dilatation of the pancreatic duct. Post-gadolinium magnetic resonance imaging is excellent in defining the origin of intra-abdominal cystic mass and intracystic septa.

TIE2 gain-of-function mutation in a patient with pancreatic lymphangioma associated with blue rubber-bleb nevus syndrome: report of a case

Abdominal lymphangioma is a rare tumor in adults. The most common location is the mesentery, but this tumor occasionally develops in the pancreas. We report a case of pancreatic lymphangioma associated with blue rubber-bleb nevus syndrome (BRBNS) in a Japanese woman. The pancreatic lymphangioma spread extensively throughout the retroperitoneum without causing any symptoms for more than 4 years after its histological diagnosis by laparoscopic biopsy. Multiple hemangiomas were also seen in the mucous membranes and on the skin. The hemangiomatosis was segregated in the dominant fashion in her family, and a germ-line gain-of-function mutation (Arg849Trp) in TIE2 gene was confirmed. To our knowledge, this is the first report of pancreatic lymphangioma occurring in association with BRBNS in a patient with genetic alteration. We describe the clinical features of this case and discuss a possible correlation between these two uncommon conditions.

Unusual cystic neoplasms in the pancreas: radiologic-pathologic correlation

Cystic neoplasms in the pancreas encompass a broad spectrum of benign, borderline, and malignant lesions that either are primarily cystic or result from the cystic degeneration of solid tumors. Although these lesions show different histologic findings, the overlap of the radiologic findings for many pancreatic cystic lesions makes differentiation difficult, and the clinical manifestations can also overlap. Therefore, some of the pancreatic cystic lesions, especially uncommon lesions, can cause diagnostic confusion, and this may result in unnecessary surgery or inappropriate follow-up. In this article, we discuss and illustrate the radiologic features of unusual cystic neoplasms and the unusual findings of the relatively common cystic neoplasms in the pancreas. We also correlate the radiologic findings with the findings on pathologic analysis.

Imaging of uncommon tumors of the pancreas

In this article, the radiological manifestations of a variety of uncommon tumors of the pancreas are illustrated, with emphasis placed on their appearance at helical CT. Islet cell tumors, because of their vascularity, typically present as masses that are hyperattenuating to the normal pancreas at dual-phase helical CT. Lymphomas appear as hypoattenuating focal lesions or can diffusely infiltrate the gland. Absence of biliary tree dilatation, despite the presence of a bulky tumor, or associated extensive retroperitoneal adenopathy should offer clues to the diagnosis. Pancreatic metastases are usually seen in patients with advanced cancers, although isolated metastases from renal cell carcinoma can occurs years after the original tumor; such patients may benefit from surgical resection. Finally, the appearance of some rare neoplasms of mesenchymal origin is discussed.