- Imaging Cystic Pancreatic Lesions: Options
- CT
- MRI
- Ultrasound
- PET/CT
- EUS (endoscopic ultrasound) - “ This article reviews pathophysiology, prevalence, significance and recommendations for management of the various pancreatic cystic lesions. A better understanding of the variety of incidentally detected pancreatic cystic lesions can help direct appropriate management.”
Incidentally detected cystic lesions of the pancreas on CT: review of literature and management suggestions
Zaheer A, Pokharel SS, Wolfgang C, Fishman EK, Horton KM
Abdom Imaging (2012) in press - Common Cystic Pancreatic Lesions
- Pseudocyst (pancreatitis)
- Serous cystadenoma
- Mucinous cystic neoplasm (MCN) - IPMN (Intraductal Papillary Mucinous Neoplasm): Facts
- Usually occurs in older population (7th decade) and a bit more common in men
- Key is pancreatic duct involvement and classified as main duct, side branch and mixed type
- Main pancreatic duct of ≥ 1 cm is suggestive of a main duct IPMN
- Main pancreatic duct IPMN has higher incidence of malignancy and usually requires surgery
- IPMN - Serous Cystadenoma: Classic Appearance
-Multiple cysts with thin septations. Central scar with central calcification is classic.
- Less common appearance is oligocystic variety (10%) with single cyst and hard to distinguish from MCN
- Cysts contain glycogen but no mucin
- Patients average age is 68 at time of dx and more common in woman - Mucinous Cystic Neoplasm of the Pancreas (MCN)
- Occurs in the 4th -5th decade of life and almost exclusively in females
- Usually in body or tail of pancreas
- No communication with the pancreatic duct (unlike IPMN) but can obstrcut the pancreatic duct
- Cysts in MCN are usually over 2 cm in size and less than 6 cysts present
- Contains ovarian type stroma - IPMN (Intraductal Papillary Mucinous Neoplasm): Facts
- Usually occurs in older population (7th decade) and a bit more common in men
- Key is pancreatic duct involvement and classified as main duct, side branch and mixed type
- Main pancreatic duct of ≥ 1 cm is suggestive of a main duct IPMN
- Main pancreatic duct IPMN has higher incidence of malignancy and usually requires surgery - IPMN (Intraductal Papillary Mucinous Neoplasm): Facts
Predictors of malignancy in IPMN include
- Lesion size (≥ 3cm)
- Interval growth over time (≥ 2mm/year)
- Mural nodule(s)
- Thick septations (enhancing)
- Clinical symptoms (including abdominal pain and unexplained episodes of pancreatitis) - Cystic/Solid Tumors (solid tumors with cystic component)
- Solid pseudopapillary tumors (SPEN)
- Neuroendocrine tumors
- Metastases to the pancreas
- Adenocarcinoma (rarely)
- Lymphoepithelial cyst - Patient Management
1. Imaging followup with CT or MRI
2. Endoscopic ultrasound (EUS)
3. Surgery
--Main duct IPMN
-- MCN
--Interval growth over 3-5 mm - Recommendations for radiologists confronted with an incidental pancreatic cyst
- Surgery should be considered for patients with cysts larger than 3 cm.
- If the lesion is a serous cystadenoma, surgery is deferred until the cyst is larger than 4 cm
- Patients with simple cysts smaller than 3 cm can be followed up, but attempts should be made to characterize cysts larger than 2 cm at detection; if this cannot be done based on the available imaging study, MI is the preferred procedure
- Cysts smaller than 1 cm cannot be further characterized by imaging, but can be followed up less frequently than cysts larger than 3 cm; in elderly patients (>80 years of age) hese cysts likely will not require further investigation - Recommendations for radiologists confronted with an incidental pancreatic cyst
- Aspiration is strongly advised to exclude pseudocyst before any surgery is performed
- Patients must remain asymptomatic during the follow-up period
Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee
Berland LL, Silverman SG, Gore RM et al.
J Am Coll Radiol 2010;7(10):754-73 - “ Serous cystadenoma of the pancreas have various distinguishing imaging features. Typically, a serous cystadenoma is morphologically classified as having either a polycystic, honeycomb, or oligocystic pattern.”
Typical and Atypical Manifestations of Serous Cystadenoma of the Pancreas: Imaging Findings With Pathologic Correlation
Choi JY et al.
AJR 2009; 193:136-142 - “ Serous cystadenoma of the pancreas have various distinguishing imaging features. Typically, a serous cystadenoma is morphologically classified as having either a polycystic, honeycomb, or oligocystic pattern. Atypical manifestations of serous cystadenoma can include giant tumors with ductal dilatation, intramural hemorrhages, solid variants, unilocular cystic tumors,interval growth and a disseminated form.”
Typical and Atypical Manifestations of Serous Cystadenoma of the Pancreas: Imaging Findings With Pathologic Correlation
Choi JY et al.
AJR 2009; 193:136-142 - “Atypical manifestations of serous cystadenoma can include giant tumors with ductal dilatation, intramural hemorrhages, solid variants, unilocular cystic tumors,interval growth and a disseminated form.”
Typical and Atypical Manifestations of Serous Cystadenoma of the Pancreas: Imaging Findings With Pathologic Correlation
Choi JY et al.
AJR 2009; 193:136-142 - Serous Cystadenoma of the Pancreas: Types
- Polycystic
- Honeycomb
- Oligocystic - Serous Cystadenoma of the Pancreas: Facts
- Serous cystadenomas can grow over time
- More common in VHL disease
- More common in the pancreatic head - Serous Cystadenoma of the Pancreas: Typical CT Findings
- Polycystic pattern is most common in 70% of cases and cysts measure 2 cm or smaller
- Central scar that calcifies is not uncommon - Serous Cystadenoma of the Pancreas: Typical CT Findings
- Honeycomb pattern is second most common in 20% of cases and numerous cysts under a cm in size
- Numerous cysts can typically not be seperated individually - Serous Cystadenoma of the Pancreas: Typical CT Findings
- Oligocystic is least common in fewer than 10% of cases and a few cysts over 2 cm in size
- Commonly called macrocystic cystadenoma and can be confused with mucinous cystic tumors - Serous Cystadenoma of the Pancreas: Atypical CT Findings
- Giant serous cystadenoma (over 10 cm)
- Serous cystadenoma with intratumoral hemorrhage
- Solid serous cystadenoma
- Unilocular cystic serous cystadenoma with calcification
- Multifocal serous cystadenoma (disseminated form)
- Cystic Pancreatic Lesions with Solid Components: Differential Dx
-Mucinous cystic neoplasm (MCN)
-IPMN
-Solid and papillary epithelial neoplasm (SPEN)
-Solid tumors with cystic degeneration (adenocarcinoma, islet cell tumor)
Cystic Lesions of the Pancreas
Khan A, Khosa F, Eisenberg RL
AJR 2011;196:1244-1245 - Unilocular Cystic Pancreatic Lesions: Differential Dx
-Pancreatic pseudocyst
-Intraductal papillary mucinous neoplasm (IPMN)
-Mucinous cystadenoma
-Oligoystic serous cystadenoma
-Lymphoepithelial cyst
-Cystic islet cell tumor - “ Multivariate analysis showed that tumor diameter and location of tumor in pancreatic head were independently associated with aggressive behavior.”
Tumor Size and Location Correlate With Behavior of Pancreatic Serous Cystic Neoplasms
Khashab MA, Shin EJ, Amateau, Canto MI, Hruban RH, Fishman EK, Cameron JC et al.
AM J Gastroenterol 2011; 106:1521-1526 - “ Preoperative CT was suggestive of SCN diagnosis in about a quarter of patients. Only tumor location in HOP were independently associated with the presence of symptoms.”
Tumor Size and Location Correlate With Behavior of Pancreatic Serous Cystic Neoplasms
Khashab MA, Shin EJ, Amateau, Canto MI, Hruban RH, Fishman EK, Cameron JC et al.
AM J Gastroenterol 2011; 106:1521-1526 - “A clinically significant proportion of (5.1%) of all SCNs were locally aggressive.Large tumor size and tumor location in the HOP were independent predictors of locally aggressive behavior in patients undergoing resection: however, small tumors of the HOP are rarely aggressive.”
Tumor Size and Location Correlate With Behavior of Pancreatic Serous Cystic Neoplasms
Khashab MA, Shin EJ, Amateau, Canto MI, Hruban RH, Fishman EK, Cameron JC et al.
AM J Gastroenterol 2011; 106:1521-1526 - “Preoperative CT was suggestive of SCN diagnosis in about a quarter of patients. Only tumor location in HOP were independently associated with the presence of symptomsA clinically significant proportion of (5.1%) of all SCNs were locally aggressive.Large tumor size and tumor location in the HOP were independent predictors of locally aggressive behavior in patients undergoing resection: however, small tumors of the HOP are rarely aggressive.”
Tumor Size and Location Correlate With Behavior of Pancreatic Serous Cystic Neoplasms
Khashab MA, Shin EJ, Amateau, Canto MI, Hruban RH, Fishman EK, Cameron JC et al.
AM J Gastroenterol 2011; 106:1521-1526 - Serous Cystadenoma of the Pancreas: Atypical CT Findings
- Giant serous cystadenoma (over 10 cm)
- Serous cystadenoma with intratumoral hemorrhage
- Solid serous cystadenoma
- Unilocular cystic serous cystadenoma with calcification
- Multifocal serous cystadenoma (disseminated form) - Serous Cystadenoma of the Pancreas: Typical CT Findings
- Polycystic pattern is most common in 70% of cases and cysts measure 2 cm or smaller
- Central scar that calcifies is not uncommon - Honeycomb pattern is second most common in 20% of cases and numerous cysts under a cm in size
- Numerous cysts can typically not be seperated individually
- Oligocystic is least common in fewer than 10% of cases and a few cysts over 2 cm in size
- Commonly called macrocystic cystadenoma and can be confused with mucinous cystic tumors - Serous Cystadenoma of the Pancreas: Facts
- Serous cystadenomas can grow over time
- More common in VHL disease
- More common in the pancreatic head - Serous Cystadenoma of the Pancreas: Types
- Polycystic
- Honeycomb
- Oligocystic "Atypical manifestations of serous cystadenoma can include giant tumors with ductal dilatation, intramural hemorrhages, solid variants, unilocular cystic tumors,interval growth and a disseminated form." Typical and Atypical Manifestations of Serous Cystadenoma of the Pancreas: Imaging Findings With Pathologic Correlation
Choi JY et al.
AJR 2009; 193:136-142 "Serous cystadenoma of the pancreas have various distinguishing imaging features. Typically, a serous cystadenoma is morphologically classified as having either a polycystic, honeycomb, or oligocystic pattern." Typical and Atypical Manifestations of Serous Cystadenoma of the Pancreas: Imaging Findings With Pathologic Correlation
Choi JY et al.
AJR 2009; 193:136-142 "Serous cystadenoma of the pancreas have various distinguishing imaging features. Typically, a serous cystadenoma is morphologically classified as having either a polycystic, honeycomb, or oligocystic pattern. Atypical manifestations of serous cystadenoma can include giant tumors with ductal dilatation, intramural hemorrhages, solid variants, unilocular cystic tumors,interval growth and a disseminated form." Typical and Atypical Manifestations of Serous Cystadenoma of the Pancreas: Imaging Findings With Pathologic Correlation
Choi JY et al.
AJR 2009; 193:136-142 "MDCT and MRI have a high accuracy in classifying cysts into mucinous and nonmucinous categories and perform similarly in estimating histologic aggressiveness." Comparitive Performance of MDCT and MRI with MR Cholangiopancreatography in Characterizing Small Pancreatic Cysts
Sainani NI et al.
AJR 2009; 193:722-731 "A dedicated thin-section dual phase technique improves the diagnostic performance of MDCT for assessing cyst morphology and should be the preferred approach for evaluating small cysts with CT, although MRI using MRCP can be resorted to in cases with doubtful or suspicious features or can be used alternatively instead of CT."
Comparitive Performance of MDCT and MRI with MR Cholangiopancreatography in Characterizing Small Pancreatic Cysts
Sainani NI et al.
AJR 2009; 193:722-731 "MRI enables more confident assessment of the morphology of small cysts than MDCT, but the accuracy of the two imaging techniques for cyst characterization is comparable." Comparitive Performance of MDCT and MRI with MR Cholangiopancreatography in Characterizing Small Pancreatic Cysts Sainani NI et al. AJR 2009; 193:722-731 "MRI enables more confident assessment of the morphology of small cysts than MDCT, but the accuracy of the two imaging techniques for cyst characterization is comparable. MDCT and MRI have a high accuracy in classifying cysts into mucinous and nonmucinous categories and perform similarly in estimating histologic aggressiveness." Comparitive Performance of MDCT and MRI with MR Cholangiopancreatography in Characterizing Small Pancreatic Cysts
Sainani NI et al.
AJR 2009; 193:722-731 - "With advancements in CT technology and improved spatial resolution, unsuspected small pancreatic cysts are being detected with increased frequency."
Prevalence of Unsuspected Pancreatic Cysts on MDCT
Laffan TA, Horton KM, Fishman EK, Hruban RH
AJR 2008;802-807
- "In this outpatient population, the prevalence of unsuspected pancreatic cysts identified on 16-MDCT was 2.6%. Cyst presence strongly correlated with increasing age and the Asian race."
Prevalence of Unsuspected Pancreatic Cysts on MDCT
Laffan TA, Horton KM, Fishman EK, Hruban RH
AJR 2008;802-807
- Serous Cystadenoma of the Pancreas: Facts
- Usually solitary but can be multiple in VHL
- Can appear solid on occasion
- Usually cystic mass described as polycystic, honeycomb, and oligocystic.
- 70% are polycystic in type
- Serous Cystadenoma: CT Findings
- Cystic lesion with collection of 2-6 cysts ranging in size from a few mm to 2 cm in size
- Central scar with or without calcification occurs in 30% of cases and is a key differential dx point
- Key differential dx is IMPN and mucinous cystic neoplasm
- Serous Cystadenoma: CT Findings
- Smooth lesion surface without lobulations, a thick enhancing wall and peripheral calcifications are more consistent with a mucinous cystic tumor
- CT of Serous Cystadenoma of the Pancreas and Mimicking Masses Kim HJ et al. AJR 2008;190:406-412
- Cystic Pancreatic Tumors: Differential Dx
- Serous cystadenoma
- Mucinous cystadenoma
- Pseudopapillary tumor
- Cystic islet cell tumor - IPMN
- Pancreatic Lesions in Von Hippel-Lindau Disease
- True cysts
- Serous cystadenomas
- Islet cell tumors
- Cystic Pancreatic Lesion: Forming a Differential Dx
- Clinical history
- Lesion size
- Lesion attenuation
- Septations or calcification
- Pancreatic duct size
- Relationship of cystic lesion to pancreatic duct
- Cystic Pancreatic Tumors: Features For Low Risk of Malignancy
- Asymptomatic patient
- Size under 3 cm
- Main pancreatic duct under 6 mm
- No solid component (mural nodule) within or associated with the cystic lesion
- No evidence of adenopathy
- No common bile duct dilatation
- Microcystic adenoma II
- Honeycomb or spongelike appearance. Septa have rich capillary network.
- Glycogen rich.
- Seen in von Hippel Lindau syndrome
- Appearance may overlap with MCN.
- Microcystic adenoma- Serous cystadenoma I
- Second commonest cystic neoplasm but less common than MCN.
- Benign, moderately vascular.
- Older women with abdominal pain
- Cluster of small cysts 2mm to 2cm. Larger cysts at periphery of lesion.
- Fibrous septa that radiate from the center
- Central stellate scar that may calcify
- Pancreatic cystic lesions
- Conservative followup.
- 1. patient wishes conservative Rx
- 2. patient asymptomatic with respect to the lesion.
- 3. lesion < 3cm, no solid component
- 4. main pancreatic duct <6mm.
- Microcystic adenoma II
- Honeycomb or spongelike appearance. Septa have rich capillary network.
- Glycogen rich.
- Seen in von Hippel Lindau syndrome
- Appearance may overlap with MCN.
- Microcystic adenoma- Serous cystadenoma I
- Second commonest cystic neoplasm but less common than MCN.
- Benign, moderately vascular.
- Older women with abdominal pain
- Cluster of small cysts 2mm to 2cm. Larger cysts at periphery of lesion.
- Fibrous septa that radiate from the center
- Central stellate scar that may calcify
- Question #3 - Are there any endorsed criteria for conservative follow-up of a cystic pancreatic lesion?
- Tanaka M et al. International Consensus Guidelines for Management of Intraductal Papillary Mucinous Neoplasms and Mucinous Cystic Neoplasms of the Pancreas. Pancreatology 2006; 6:17-32.
- Consensus of the Working Group of the International Association of Pancreatology.
- Cystic Neoplasms of the Pancreas: Differential Dx
- Pancreatic pseudocyst
- True pancreatic cyst
- Serous cystadenoma
- Mucinous cystadenoma/cystadenocarcinoma
- IPMN
- Solid Papillary Epithelial Neoplasm
- Cystic Pancreatic Lesions: Differential Diagnosis
- Pancreatic cyst (congenital or true cyst)
- Pseudocyst (post pancreatitis)
- Microcystic adenoma
- Macrocystic (Mucinous) Cystic Tumor
- Intraductal Papillary Mucinous Tumor (IPMN)
- Islet cell tumors (especially non-functioning tumors)
- Hamoudi tumor (solid papillary epithelial neoplasm)
- Pancreatic cyst (congenital or true cyst): Facts
- Usually multiple and commonly associated with diseases that involve other organs
- Autosomal dominant polycystic kidney disease (5% of cases)
- Von Hippel-Lindau disease (50-75% of cases)
- Cystic fibrosis-single or numerous cysts
- Pancreatic cyst (congenital or true cyst): Facts
- May be solitary
- True cyst
- Lymphoepithelial cyst
- Microcystic Adenoma: facts
- Benign neoplasm
- F > M by 2-1
- Usually detected in 7th decade
- Found in von Hippel-Lindau syndrome
- Cysts usually under 2 cm. and may contain central stellate scar (often calcified)
- Contains glycogen but no mucin
- Macrocystic Serous Adenoma of the Pancreas
- Benign lesion like classic microcystic serous adenoma but the septae are poorly visualized
- May be impossible to distinguish from a macrocystic mucinous tumor
- Macrocystic Serous Adenoma of the Pancreas: Radiologic-Pathologic Correlation
Khurana B et al.
AJR 2003;181:119-123
- Mucinous Cystic Tumor: Facts
- Malignant neoplasm also called Cystadenocarcinoma or Macrocystic Adenoma neoplasm
- F > M by 9-1
- Usually detected in 5th to 6th decade
- Cysts often irregular and usually greater than 2 cm.
- Contains mucin
- Mucinous Cystic Tumor: Facts
- May contain peripheral curvilinear cyst wall calcification
- Can be difficult to distinguish from benign microcystic cystadenoma
- Cystic Neoplasms of the Pancreas: WHO Classification 2000
- Serous microcystic adenoma
- Serous oligocystic adenoma
- Serous cystadenocarcinoma
- Mucinous cystadenoma
- Mucinous cystic tumor-bordeline
- Mucinous cystadenocarcinoma
- Noninvasive
- Invasive cont.
- Cystic Neoplasms of the Pancreas: WHO Classification 2000
- Intraductal papillary mucinous adenoma
- Intraductal papillary mucinous neoplasm-borderline
- Intraductal papillary mucinous carcinoma
- Noninvasive
- invasive
- Macrocystic Serous Cystadenoma: CT Findings
- Location in the pancreatic head
- Lobulated contour
- Thin wall
- Absence of wall enhancement
- If all three findings present specificity for dx is 100%
- von Hippel-Lindau Disease: Pancreatic Pathology
- Occur in up to 77% of patients
- Lesions include
- Simple pancreatic cysts
- Serous cystadenomas
- Neuroendocrine tumors
- Pancreatic carcinoma
- Cystic Pancreatic Mass: Differential Diagnosis
- Pseudocyst
- Serous cystadenoma
- Mucinous cystic tumor
- IMPN (intraductal mucinous tumor)
- SPEN (solid and papillary neoplasm)
- Cystic islet cell tumor
- Serous Cystadenoma: Facts
- AKA microcystic cystadenoma
- Usually woman over age 60
- Multiple 0.2-2.0 cm cysts
- Central calcified stellate scar classic
- May seem cystic or even solid on CT
- Mucinous Cystic Tumor: Facts
- Enhancing septations and nodules are common
- Peripheral calcification is seen in up to 25% of cases
- Malignant potential and should be removed
- Multiple True Pancreatic Cysts: Differential Diagnosis
- Von Hippel-Lindau disease
- Beckwith-Wiedermann syndrome
- Autosomal dominant PCK
- Pancreas
- Meckel-Gruber syndrome
- Guidelines
- 1. Asymptomatic cystic lesions without main duct dilatation [> 6 mm], those without mural nodules, and those < 30 mm in size have a low risk of progressing to invasive cancer in near-term [ 12 –to 36 month] followup.
- 2. Yearly followup if lesion is <10 mm in size. 6-12 month follow-up for lesions 10-20 mm. 3-6 month followup for lesions >20 mm.
- 3. Interval can be lengthened after 2 yrs of no change
- 4. Appearance of sx attributable to the cyst [eg pancreatitis], presence of intramural nodules, cyst size > 30 mm, or dilatation of pancreatic duct >6mm are indications for resection.
- - 1.Proliferation of mucinous epithelial cells lining pancreatic ducts- arranged in papillary patterns.
- 2. Intraluminal accumulation of mucin and cystic dilatation of ducts.
- 3. Spectrum of architectural atypia from benign to malignant.
- IPMN
- 4. 1/3 of cases associated with invasive carcinoma.
- 5. Communicate with pancreatic duct, ( unlike MCN ).
- 6. No ovarian stroma.
- 7. Mucin may be seen pouring into duodenum from patulous orifice of pancreatic duct.
- IPMN
- 1. IPMN Adenoma
- 2. IPMN Borderline
- 3. IPMN Carcinoma in situ
- 4. IPMN Invasive carcinoma
- A. Colloid Carcinoma-Muc 2
- B. Ductal Carcinoma- Muc 1
- Conclusions from recent studies
- Commonest small cysts are MCN, IPMN, and serous.
- Very few pseudocysts in absense of pancreatitis.
- Fewer than 5% of incidentally detected pancreatic cysts <2cm are malignant.
- Patient’s choice: Follow, Bx under US, surgery.
- General consensus:
- 1. Under 2 cm observe.
- 2. >2cm Young and middle-aged resect.
- 3. >2cm older and less fit. Endoscopic US with fine needle aspiration, [ 40-50% sensitivity, 99+% specificity ]. Resect if mucin, high CEA, mucinous epithelium, malignant cells, or neuroendocrine cells.
- The natural history of the incidentally discovered small simple pancreatic cyst; long term follow-up and clinical implications
- Handrich SJ et al. AJR 2005; 184: 20-23. Mayo Clinic.
- <2.0 cm cysts dx by sonography or CT 1985-1996.
- 79 pts. 49 adequate follow-up.
- 13 [ 59% ] no change or smaller. Mean size 8 mm, mean follow-up 9 years.
- 9 [ 415 ] enlarged. Mean 14 mm to 26 mm. Mean follow-up 8 years. One pt operated on- pseudocyst.
- 27 clinical follow-up or response to questionaire. Mean follow-up 10 years. None developed pancreatic disease.
- 18 patients died. No suggestion of pancreatic disease.
- 12 patients lost to follow-up.
- Pancreatic cysts 3 cm or smaller: How aggressive should treatment be?
- Sahani DV et al Radiology 2006; 238: 912-919. Mass General
- 510 pts with cysts 1998-2004. 122 pancreatitis excld. 313/388 {80.6%} <3cm.
- 86 patients in study with adequate data. Aged 24-89 years.
- 48 surgery vs 38 non surgical.
- 75 benign, 8 borderline malignant, 3 ca in situ.
- Results of surgery: 37 benign MCN 13, IPMN side branch 14, serous 3, pseudocyst, cystic neuroendocrine 2, lymphoepithelial cyst 1, unclass 2 11 malignant
- 8 borderline : 6 side-branch, 2 MCN. 3 ca in situ: 2 side-branch, 1 MCN.
- 38 pts followed, all had US bx -1 later developed side-branch IMN with ca in situ.
- Cystic pancreatic neoplasms- Observe or operate?
- Spinnelli KS et al. Annals of Surgery 2004; 239: 651-659. U.Wisconsin. 1995-2002.
- 290 cysts 1.2%. 132 hx pancreatitis thus, 168, 0.7% incidence of presumed neoplastic cysts.
- 79 patients followed -16 months mean.
- 15 increased in size [ 19% ]
- 47 no change in size [ 59% ]
- 17 decrease in size [ 22% ]
- 49 had surgery
- 14 benign 10 serous, 2 SPEN, 1 lymphoep, 1 simple cyst
- 25 premalignant 16 MCN, 5 IPMn, 4 cystic neuroendocrine
- 10 malignant 7 IPMN with Ca, 3 MCN
- Recommend surgery if symptomatic, increasing, or fit older pts, since 60% of cysts in pts over 60 were malignant.
- Intraductal Papillary Mucinous Tumor (IPMN): Facts
- Equal frequency men and woman
- Usually detected in 6th and 7th decade
- Commonly associated with dilated pancreatic duct
- Lesions may be multiple and variable in size
- Intraductal Papillary Mucinous Tumor (IPMN): Facts
- Initially referred to as mucin producing pancreatic neoplasms
- May be incidental finding or patients present with pancreatitis like symptoms
- Up to 60% occur in the head/uncinate process
- Cystic Endocrine Tumors
- Insulinomas
- Gastrinomas
- Glucagonomas
- Non-functioning tumors
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