Any information contained in this pdf file is automatically generated from digital material submitted to epos by third parties in the form of scientific presentations. Aug 22, 2011 cystic variants of solid tumors are some of the many rare cystic lesions that may also be present in the pancreas. Classification diagnosis was performed for cystic pancreatic lesions using ultrasound us and contrastenhanced ultrasound ceus to explore the diagnostic value of ceus by comparison with enhanced ct. It also allows for fineneedle aspiration fna of cystic lesions is biochemical, cytological and dna analysis that might be further helpful for diagnosis and differentiation.
Analysis of small cystic lesions of the pancreas springerlink. Worlds best powerpoint templates crystalgraphics offers more powerpoint templates than anyone else in the world, with over 4 million to choose from. Mri is a powerful tool for detection, characterization, and surveillance of both cystic pancreatic lesions, such as serous and mucinous tumors, and intraductal papillary mucinous tumors, as well as neuroendocrine tumors. Sixtyfour cases with cystic pancreatic lesions were included in this study. Technologic innovations in mdct and mri have led to improvement in analysis and morphologic differentiation of cystic pancreatic lesions and are widely considered the primary imaging modalities in the care of patients with cystic lesions of the pancreas.
Diagnosis and management of cystic pancreatic lesions mayo. Cystic lesions of the pancreas are a group of pancreatic lesions characterized by a cystic appearance. When symptoms are present, the most common presentation is recurrent abdominal pain, nausea, and vomiting as result of mild pancreatitis. We have also seen several cases of large left upper pole renal cysts that were confused with cystic tumors of the pancreas, especially when the cystic lesions had thick or atypical calcifications,, fig 21. Cystic neoplasms of the pancreas may be more frequent than previously recognized and are being identified with increasing frequency as the use of abdominal ct scanning has increased. Pancreatic cystic neoplasms, mucinous cystic neoplasm, molecular analysis. The cystic lesions of pancreas were classified into four types by us, ceus, and ct. Mucinous cystic neoplasm is a frequent type of cystic neoplasm and has a. Differential diagnosis of cystic pancreatic lesions. Clinical and pathologic correlation of 84 mucinous cystic neoplasms of the pancreas. The prevalence of cystic lesions of the pancreas has been estimated to range from 2. Sep 01, 2003 we have also seen several cases of large left upper pole renal cysts that were confused with cystic tumors of the pancreas, especially when the cystic lesions had thick or atypical calcifications,, fig 21.
Among this heterogeneous group, benign neoplasms predominate, particularly those with mucinous lining. Cystic lesions of the pancreas differential radiology. A cystic lesion of the pancreas is a radiographic finding that has a broad histologic differential. Cystic pancreatic lesions have a diverse morphology and range from benign. Theyll give your presentations a professional, memorable appearance the kind of sophisticated look that todays audiences expect. There is currently no gold standard for diagnosis or surveillance. Wgo practice guidelines world gastroenterology organisation. Pancreatic cystic lesions are an increasing problem and investigation of these cysts can be fraught with difficulty. Sahai pancreatic tail mass primary vs pancreatic met fna dr. The enhancement pattern is variable and often mimics the enhancement characteristics of primary tumor. Despite the advances, concerning preoperative diagnosis, in a lot of cases of pancreatic cystic lesions final. Mucinous cystic neoplasm is a frequent type of cystic neoplasm and has a malignant potential. Age at presentation, gender, location and tumor size are highly variable, with the exception of solid pseudopapillary tumor.
Mdct mdct is the primary modality for imaging of cystic pancreatic lesions, including ipmns, owing to its high spatial and temporal resolu. Cystic lesions guidelines pancreas a b s t r a c t cystic lesions of the pancreas are increasingly recognized. Eus findings alone are not sufficiently accurate to diagnose definitively the type of cystic lesion of the pancreas or to determine if it is or could become malignant b. Any information contained in this pdf file is automatically. Pancreatic neuroendocrine tumors are typically solid neoplasms but in very rare cases present as cystic lesions. Solid pancreatic tumors such as pancreatic ductal adenocarcinoma pdac, solid pseudopapillary tumor spt, and pancreatic endocrine tumor pet may occasionally manifest as cystic lesions. Sahai pancreatic normal anatomy and mediastinum dr. Diagnosis and management of pancreatic cystic lesion.
Most patients with a pancreatic cystic lesion have nonspecific symptoms. Cystic lesions of the pancreas annals of gastroenterology. T1 eusguided fna with cyst fluid analysis in pancreatic cystic lesions. Although most cysts are benign, some are malignant or premalignant. Pcns account for different biological entities with different potential for malignant transformation. Neoplasm and intraductal papillary mucinous neoplasm ipmn are the most. Evaluation and management of cystic lesions of the pancreas.
Classify cystic pancreatic lesions differentiate neoplastic from nonneoplastic cysts identify neoplastic cysts with malignant potential overview of. Different types of benign or malignant cystic lesions can be observed in the pancreas. There are three basic types of pancreatic cystic lesions. It has been shown to detect invasive cancer in a cystic lesion. Pancreatic neurofibromas are rare nonepithelial neoplasms of the pancreas. Premalignant cystic lesions of the pancreas include mucinous cystic neoplasms and intraductal papillary mucinous neoplasms. Current clinical and research efforts for cystic neoplasms. Management of cystic lesions of the pancreas springerlink. One of the most important differences between cystic neoplasm and pseudocyst is its radiological picture and a history of abdominal trauma, acute or chronic pancreatitis. As indicated above, some pancreatic cystic lesions may evolve into adenocarcinoma of the pancreas. Cystic neoplasms of the pancreas healthcare baylor. The american college of radiology acr published guidelines on managing incidental cystic pancreatic lesions in 2017 11.
Cystic tumors account for 10% of all pancreatic cysts, but only 1% of all pancreatic malignancies. The diagnosis of cystic tumors in the pancreas is extremely difficult and the use of endoscopic ultrasound and fineneedle aspiration might be helpful in the workup of patients with cystic neuroendocrine tumors in the pancreas. In this study, we have put together our accumulated experience with cystic manifestations of various solid tumors of the pancreas. For example, ductal adenocarcinoma, acinar adenocarcinoma, and neuroendocrine tumors all may undergo cystic degeneration and may present as primarily cystic lesions table 1 5, 7, 8, 18. The fundamental issue is whether the cyst is neoplastic, and, if so, what is its risk for malignant degeneration.
Cystic pancreatic lesions are more and more frequently found due to the large use of imaging procedures during systematic checkup, workup of abdominal pain, or followup of a patient with a nonpancreatic malignancy. Pdf imaging of indeterminate pancreatic cystic lesions. Flowchart chart 2 specifying the management of incidental pancreatic cysts 1. Diagnosis and management of cystic lesions of the pancreas. Petct is an evolving modality for detecting malignancy in cystic pancreatic lesions. Pancreatic neurofibroma radiology reference article. Winner of the standing ovation award for best powerpoint templates from presentations magazine. Org september 16, 2004 cystcyst c eop as s ic neoplasms s organ of origin. It is important to be familiar with their imaging features and characteristics. Pancreatic tumors can be identified in up to 80% of patients with multiple endocrine neoplasia type 1, as shown by intensive anatomic studies of the pancreatic tissue 1, 3, 4. While pseuodocysts have historically accounted for the majority of benign pancreatic cysts, there are a number of rare, benign cystic lesions of the pancreas that can mimic neoplastic cysts. Pancreatic cystic lesions are classifi ed under pathology terms into simple retention cysts, pseudocysts and cystic neoplasms. Highresolution computed tomography provides detailed information about cyst. Application of contrastenhanced ultrasound in cystic.
From this pool we gathered 27 cases of pancreatic neuroendocrine tumors, 25 serous adenomas, 2 intrapancreatic splenules and 4 pancreatic hypervascular metastases table 1 on page 3. Retroperitoneal lesions, extrinsic to the pancreas, can of course mimic pancreatic cystic lesions, when close to the gland. Serous cysts are considered benign lesions without malignant potential, while mucinous cystic lesions are considered premalignant or malignant. Pancreatic and peripancreatic diseases mimicking primary. Among lesions that are not pseudocysts, serous cystadenoma, mucinous cystic. Pancreatic cystic lesions are being increasingly identified. 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. Cystic pancreatic lesions have a broad differential diagnosis. Pdf clinical approach to incidental pancreatic cystic lesions. Intraductal papillary mucinous neoplasm sahani dv et al.
The widespread use of highquality ct scanning in recent years has led to an increasing number of patients in whom identification of small asymptomatic. Cystic lesions of the pancreas comprise of a heterogeneous group of diagnostic entities, some of which are benign such as inflammatory pseudocysts or serous. Among this heterogeneous group, benign neoplasms predominate, particularly those. Diagnostic difficulties in the differentiation of pancreatic pseudocyst and cystic pancreatic neoplasm can lead to misdiagnosis and inappropriate treatment, since clinical symptoms, preoperative. Owing to improvements in imaging techniques, cystic lesions of the pancreas are being identified more often. Characterization of cystic pancreatic neoplasms by computed. Clinical approach to incidental pancreatic cystic lesions.
Sahai pancreatic pseudocyst exam using a radial scope dr. There have been few reports on 1 the nature and pathogenesis of small cystic lesions of the pancreas, 2 their incidence, age distribution, and location, and 3 their significance as potential precursors of intraductal papillary tumors, mucinous cystic tumors, and duct cell carcinomas. The main parasitic lesion of the liver is the hydatid cyst, and the nonparasitic lesions are again divided into benign, premalignant and malignant. Diff erent types of benign or malignant cystic lesions can be observed in the pancreas. Cystic lesions of the pancreas differential radiopaedia. Cystic pancreatic lesions comprise a wide variety of lesions that are being. The frequency of cystic pancreatic lesions was 20% in 1,444 american people who had a systematic magnetic resonance imaging mri. The majority of pancreatic cystic lesions are nonneoplastic cysts, which are predominantly pancreatic pseudocysts pps and are mostly seen as a local complication of pancreatitis. From 2000 to 2006, 376 patients with pancreatic solid tumor. Epidemiology, diagnosis, and management of cystic lesions. This is important because a precise diagnosis determines the treatment and surgical approach. Cystic neoplasms of the pancreas and tumorlike lesions with cystic features. Diagnosis and management of cystic pancreatic lesions.
Threedimensional vr may be used to demonstrate the 3d equivalent of the beak sign ie, a mass that arises from the kidney and. Cystic lesions of the pancreas, even when found incidentally, require diagnostic evaluation regardless of size because they may represent malignant or premalignant neoplasms b. In a recent study of over 1,400 cystic lesions of the pancreas, 7% were cystic. They are similar to neurofibromas found elsewhere in the body, and are associated with neurofibromatosis type i. Cystic variants of solid tumors are some of the many rare cystic lesions that may also be present in the pancreas. Solid tumors of the pancreas can put on a mask through.
Any information contained in this pdf file is automatically generated from digital material submitted to. The full text of this article is available in pdf format. It is important to diagnose cystic lesions in order to properly manage. This differential includes nonneoplastic pseudocysts, benign neoplastic cysts, premalignant cysts, and cystic lesions with invasive carcinoma. The clinician must balance his or her practice between the risk.
Cystic lesions of the pancreas are a diverse group of lesions, ranging from benign processes to invasive malignant tumors, and often can be morphologically differentiated on ct and mri on the basis of characteristic features. The following imaging modalities can be used either independently or in combination to help in the diagnosis and manage ment of cystic pancreatic lesions. While some lesions show benign behaviour serous cystic neoplasm, others have an unequivocal malignant potential mucinous cystic neoplasm, branch and main duct intraductal papillary mucinous neoplasm and solid pseudopapillary. An unusual presentation of pancreatic pseudocyst mimicking. Cystic pancreatic lesion an overview sciencedirect topics. Epithelial growth of small cystic lesions in 300 consecutive autopsy cases and in seven cases. Clinical presentation if they do cause symptoms, it wil. The majority of metastatic lesions appear as a large, solitary mass with welldefined margins, but cystic lesions may occur, particularly from cystadenocarcinoma of the ovary and melanoma. Epidemiology, diagnosis, and management of cystic lesions of. The nonneoplastic cysts are better divided histologically into epithelial cysts with retention cysts being the most common and nonepithelial ones with. Cystic lesions of the pancreas comprise of a heterogeneous group of diagnostic entities, some of which are benign such as inflammatory pseudocysts or serous cystadenomas.
Broadly, these pancreatic cystic lesions can be classified into neoplastic and nonneoplastic pancreatic cystic lesions. Pancreatic cystic lesions are classified under pathology terms into simple retention cysts, pseudocysts and cystic neoplasms. However, some imaging features together with the clinical setting may help to make the differential diagnosis. Eusguided fna with cyst fluid analysis in pancreatic. On mri t2weighted images, it often appears as a hyperintense, unilocular cyst with a thick enhancing wall 43. Eusguided fna with cyst fluid analysis in pancreatic cystic. Because the mr signal is so sensitive to fluid, fluids in the cystic lesions as well as in the ducts are well depicted. Although little is known on the true prevalence of pancreatic cysts, physicians are currently more frequently confronted with pancreatic cysts because of the increasing use of sophisticated crosssectional abdominal imaging. Fluid hyperintensity on t2weighted images and absent enhancement optimally confirmed with subtracted images establish cystic etiology. Clinical decision making is driven by the differential diagnosis of the cyst and, for the asymptomatic patient, its likelihood of causing harm. Ppt diagnosis of pancreatic cystic neoplasms powerpoint. Neoplasia, cysts, imaging sequences, mr, ct, neuroradiology brain.