Pancreatic cysts: etiology, diagnosis and management

AbstractPancreatic cysts involve a wide spectrum of pathologies from post-inflammatory cysts to malignant neoplasms. Pancreatic pseudocysts, serous cystadenomas, mucinous cystadenomas, intraductal papillary mucinous neoplasms (IPMNs) and solid pseudopapillary tumors occur most frequently. Differential diagnosis involves the following imaging investigations: transabdominal ultrasonography (TUS), contrast enhanced ultrasonography (CEUS) and endoscopic ultrasonography (EUS), computed tomography (CT), magnetic resonance (MR) and magnetic resonance cholangiopancretography (MRCP), endoscopic retrograde cholangiopancretography (ERCP). The cyst fluid cytology is performed in difficult differential diagnosis between pseudocysts and benign and potentially malignant or malignant tumors. Most frequently, viscosity, amylase, CEA and CA 19-9 levels are determined. Imaging findings should be correlated with cytology. The management depends on the cyst type and size. Small asymptomatic pseudocysts, serous cystadenomas and branchduct IPMNs should be carefully observed, whereas symptomatic large or uncertain serous cystadenomas and cystadenocarcinomas, mucinous cystadenomas and cystadenocarcinomas, main-duct IPMNs and large branch-duct IPMNs with malignant features, serous and mucinous cystadenocarcinomas, and solid pseudopapillary tumors require surgery. Pseudocysts are usually drained. Percutaneous / EUS-guided or surgical cyst drainage can be performed. Complicated and uncertain pseudocysts and cystic tumors need surgical resection. The type of surgery depends on cyst location and size and includes proximal, central, distal, total pancreatectomies and enucleation.

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Pancreatic Cysts: Pathologic Classification, Differential Diagnosis, and Clinical Implications

Archives of Pathology & Laboratory Medicine ◽

10.5858/133.3.423 ◽

2009 ◽

Vol 133 (3) ◽

pp. 423-438 ◽

Cited By ~ 26

Author(s):

Olca Basturk ◽

Ipek Coban ◽

N. Volkan Adsay

Keyword(s):

Differential Diagnosis ◽

Malignant Potential ◽

Common Finding ◽

Pancreatic Cysts ◽

Pancreatic Ducts ◽

Low Grade ◽

Cystic Lesions ◽

Dismal Prognosis ◽

Cystic Tumors ◽

Pathologic Classification

Abstract Context.—Cystic lesions of the pancreas are being recognized with increasing frequency and have become a more common finding in clinical practice because of the widespread use of advanced imaging modalities and the sharp drop in the mortality rate of pancreatic surgery. Consequently, in the past 2 decades, the nature of many cystic tumors in this organ has been better characterized, and significant developments have taken place in the classification and in our understanding of pancreatic cystic lesions. Objective.—To provide an overview of the current concepts in classification, differential diagnosis, and clinical/biologic behavior of pancreatic cystic tumors. Data Sources.—The authors' personal experience, based on institutional and consultation materials, combined with an analysis of the literature. Conclusions.—In contrast to solid tumors, most of which are invasive ductal adenocarcinomas with dismal prognosis, cystic lesions of the pancreas are often either benign or low-grade indolent neoplasia. However, those that are mucinous, namely, intraductal papillary mucinous neoplasms and mucinous cystic neoplasms, constitute an important category because they have well-established malignant potential, representing an adenoma-carcinoma sequence. Those that are nonmucinous such as serous tumors, congenital cysts, lymphoepithelial cysts, and squamoid cyst of pancreatic ducts have no malignant potential. Only rare nonmucinous cystic tumors that occur as a result of degenerative/necrotic changes in otherwise solid neoplasia, such as cystic ductal adenocarcinomas, cystic pancreatic endocrine neoplasia, and solid-pseudopapillary neoplasm, are also malignant and have variable degrees of aggressiveness.

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Pancreatic Cysts after Endoscopic Ultrasonography-Guided Ethanol and/or Paclitaxel Ablation Therapy: Another Mimic of Pancreatic Pseudocysts

Pathobiology ◽

10.1159/000518050 ◽

2021 ◽

pp. 1-7

Author(s):

Soyeon An ◽

You-Na Sung ◽

Sung Joo Kim ◽

Dong-Wan Seo ◽

Sun-Young Jun ◽

...

Keyword(s):

Surgical Resection ◽

Cystic Tumor ◽

Pancreatic Pseudocysts ◽

Pancreatic Cysts ◽

Clinical Impression ◽

Female Ratio ◽

Ablation Therapy ◽

Cystic Tumors ◽

Wide Range ◽

Egg Shell

Background: Endoscopic ultrasound-guided ablation (EUS-A) therapy is a minimally invasive procedure for pancreatic-cystic tumors in patients with preoperative comorbidities or in patients who are not indicated for surgical resection. However, histopathologic characteristics of pancreatic cysts after ablation have not been well-elucidated. Methods: Here, we analyzed pathological findings of 12 surgically resected pancreatic cysts after EUS-A with ethanol and/or paclitaxel injection. Results: Mean patient age was 49.8 ± 13.6 years with a 0.3 male/female ratio. Clinical impression before EUS-A was predominantly mucinous cystic neoplasms. Mean cyst size before and after ablation therapy was similar (3.7 ± 1.0 cm vs. 3.4 ± 1.6 cm; p = 0.139). Median duration from EUS-A to surgical resection was 18 (range, 1–59) months. Mean percentage of the residual neoplastic lining epithelial cells were 23.1 ± 37.0%. Of the resected cysts, 8 cases (67%) showed no/minimal (<5%) residual lining epithelia, while the remaining 4 cases (33%) showed a wide range of residual mucinous epithelia (20–90%). Ovarian-type stroma was noted in 5 cases (42%). Other histologic features included histiocytic aggregation (67%), stromal hyalinization (67%), diffuse egg shell-like calcification along the cystic wall (58%), and fat necrosis (8%). Conclusion: Above all, diffuse egg shell-like calcification along the pancreatic cystic walls with residual lining epithelia and/or ovarian-type stroma were characteristics of pancreatic cysts after EUS-A. Therefore, understanding these histologic features will be helpful for precise pathological diagnosis of pancreatic cystic tumor after EUS-A, even without knowing the patient’s history of EUS-A.

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Extrahepatic Fat-Containing Lesions of the Abdomen and Pelvis: An Organ-Based Approach to Differential Diagnoses

Canadian Association of Radiologists Journal ◽

10.1177/0846537119887871 ◽

2020 ◽

Vol 71 (1) ◽

pp. 19-29 ◽

Cited By ~ 1

Author(s):

Andrew D. Chung

Keyword(s):

Magnetic Resonance Imaging ◽

Differential Diagnosis ◽

Magnetic Resonance ◽

Differential Diagnoses ◽

Malignant Neoplasms ◽

Resonance Imaging ◽

Invaluable Tool

The presence of intralesional fat provides an invaluable tool for narrowing the differential diagnosis for both benign and malignant neoplasms of the abdomen and pelvis. The ability to characterize intralesional fat is further expanded by the ability of magnetic resonance imaging to detect small quantities (intravoxel) of fat. While the presence of intralesional fat can help to provide a relatively narrow set of diagnostic possibilities, depending on the type of fat (macroscopic vs intravoxel) that is present and the organ of origin, radiologists must be aware of uncommon mimickers of pathology, both benign and malignant.

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Diagnosing necrotic meningioma: a distinctive imaging pattern in diffusion MRI and MR spectroscopy

The Neuroradiology Journal ◽

10.1177/1971400916678241 ◽

2016 ◽

Vol 30 (1) ◽

pp. 57-61

Author(s):

Gal Ben-Arie ◽

Yonatan Serlin ◽

Sebastian Ivens ◽

Mony Benifla ◽

Emanuela Cagnano ◽

...

Keyword(s):

Differential Diagnosis ◽

Magnetic Resonance ◽

Diffusion Weighted Imaging ◽

Diffusion Mri ◽

Final Diagnosis ◽

Brain Lesions ◽

Malignant Neoplasms ◽

Resonance Spectroscopy ◽

Advanced Imaging ◽

Work Up

The differential diagnosis of necrotic meningiomas includes brain abscess and malignant neoplasms. We report and discuss hereby the work-up of two patients diagnosed with necrotic meningioma using diffusion-weighted imaging, magnetic resonance spectroscopy, resective surgery, and histopathology. The purpose of the present article is to add to the scant literature on the use of advanced imaging modalities in the routine investigation of brain lesions and their utility in arriving at the final diagnosis.

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Differential Diagnosis of Pancreatic Serous Cystadenomas and Mucinous Cystadenomas: Utility of Texture Analysis in Combination with Morphological Characteristics

10.21203/rs.2.13612/v1 ◽

2019 ◽

Author(s):

Jing Yang ◽

Xinli Guo ◽

Weiwei Zhang ◽

Jinen Song ◽

Xuelei Ma ◽

...

Keyword(s):

Differential Diagnosis ◽

Receiver Operating Characteristic ◽

Texture Analysis ◽

Operating Characteristic ◽

Morphological Characteristics ◽

Textural Features ◽

Reliable Technique ◽

Serous Cystadenomas ◽

Mucinous Cystadenomas ◽

Receiver Operating

Abstract Background Texture analysis of medical images has been reported to be a reliable technique for differential diagnosis of neoplasms. This study was to investigate the performance of textural features and the combined performance of textural features and morphological characteristics in the differential diagnosis of pancreatic serous and mucinous cystadenomas. Methods We retrospectively reviewed 59 patients with pancreatic serous cystadenoma and 32 patients with pancreatic mucinous cystadenoma at our hospital. Textural features were extracted using the LifeX software, and the least absolute shrinkage and selection operator (LASSO) method was applied to select the textural features. The differential diagnostic abilities of morphological features, textural features, and their combination were evaluated using receiver operating characteristic (ROC) analysis, with the area under the receiver operating characteristic curve (AUC) as the main indicator. Results The combination of morphological characteristics and textural features showed a higher AUC (0.893, 95% CI 0.816-0.970) than use of morphological characteristics (0.783, 95% CI 0.665-0.900) or textural features (0.777, 95% CI 0.673-0.880) alone. Conclusions In conclusion, our preliminary results highlighted the potential of CT texture analysis to discriminate pancreatic serous cystadenomas from mucinous cystadenomas. Furthermore, the combination of morphological and textural features can significantly improve the diagnostic performance, which may provide a reliable method to select patients with indication of surgical intervention in consideration of the different treatment principles of the two diseases.

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Cystic Pancreatic Lesions: A Review of Diagnosis and Management

Journal of Gastrointestinal and Abdominal Radiology ◽

10.1055/s-0040-1708107 ◽

2020 ◽

Vol 3 (01) ◽

pp. 035-039

Author(s):

Ott Le ◽

Juan J. Ibarra Rovira

Keyword(s):

Magnetic Resonance ◽

Magnetic Resonance Cholangiopancreatography ◽

Pancreatic Cysts ◽

Imaging Features ◽

Cross Sectional ◽

Imaging Protocol ◽

Pathologic Evaluation ◽

Serous Cystadenomas ◽

Cross Sectional Imaging ◽

Cystic Pancreatic Lesions

AbstractPancreatic cysts are commonly seen with increasing use of cross-sectional imaging. They range from a benign inflammatory process that can produce pseudocysts to malignant lesions such as mucinous cystadenocarcinoma. Other common pancreatic cysts include intraductal pancreatic mucinous neoplasms and serous cystadenomas. Optimized imaging protocol dedicated to imaging the pancreas is required, such as multiphasic computed tomography, magnetic resonance imaging/magnetic resonance cholangiopancreatography, or endoscopic ultrasound, to fully detect and characterize the lesions. A confident diagnosis can be made on imaging when features such as calcifications, pancreatic duct diameter, main duct communication, and mural nodules are assessed. Additionally, pathologic evaluation from fluid/tissue sampling aid in diagnosis. Optimal management of pancreatic cysts is achieved based on the imaging features, conveying key findings in the radiology report, pathologic evaluation, and clinical factors.

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Magnetic resonance imaging in the assessment of cystic pancreatic lesions: differentiation of benign and malignant lesion status

Acta Radiologica ◽

10.1080/02841850500334997 ◽

2006 ◽

Vol 47 (2) ◽

pp. 121-129 ◽

Cited By ~ 10

Author(s):

E. Lopez Hänninen ◽

M. Pech ◽

J. Ricke ◽

T. Denecke ◽

H. Amthauer ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Contrast Material ◽

Malignant Lesion ◽

Pancreatic Tumors ◽

Resonance Imaging ◽

Serous Cystadenomas ◽

Morphological Criteria ◽

Cystic Tumors ◽

Cystic Pancreatic Lesions

Purpose: To characterize cystic pancreatic lesions and tumors with magnetic resonance imaging (MRI), and to assess the value of morphological criteria in differentiating pseudocysts versus cystic tumors and benign versus malignant cystic tumors. Material and Methods: Twenty-three patients with cystic pancreatic tumors or lesions underwent plain and contrast-material-enhanced MRI, including magnetic resonance cholangiopancreatography (MRCP). The MR findings were characterized and analyzed by two readers, and the role of various imaging criteria and combinations thereof for final lesion assignment were assessed. Final diagnoses were obtained from the results of open surgery ( n = 19) and/or biopsy ( n = 4). Results: Final diagnoses included cystic tumors ( n = 11) and pseudocysts ( n = 12). The lesions were located in the head (56%) and body or tail (44%). Lesion diameters ranged from 7 to 50 mm. Various lesion contrast enhancement patterns were observed for both benign and malignant lesions. Serous cystadenomas were located in the head, they were lobulated, and had wall diameters⩽2 mm; with the combination of these characteristics all patients with serous cystadenoma could be identified, whereas in no other patient was this constellation observed. Conclusion: MRI facilitated the diagnosis of serous cystadenomas, although no definite morphologic criterion for the differentiation between pseudocysts and mucinous cystadenomas was identified. In consideration of the substantial therapeutic consequences, either diagnostics in unclear cystic pancreatic lesions should comprise cyst fluid analysis if necessary, or eligible patients should be referred for surgical resection.

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Fat-Containing Lesions of the Liver: A Review of Differential Diagnoses

Canadian Association of Radiologists Journal ◽

10.1177/0846537119885693 ◽

2020 ◽

Vol 71 (1) ◽

pp. 12-18

Author(s):

Andrew D. Chung

Keyword(s):

Magnetic Resonance Imaging ◽

Differential Diagnosis ◽

Magnetic Resonance ◽

Differential Diagnoses ◽

Malignant Neoplasms ◽

Imaging Findings ◽

Resonance Imaging ◽

Invaluable Tool

The presence of intralesional fat provides an invaluable tool for narrowing the differential diagnosis for both benign and malignant neoplasms of the abdomen and pelvis. The ability to characterize intralesional fat is further expanded by the ability of magnetic resonance imaging to detect small quantities (intravoxel) of fat. The differential diagnosis of fat-containing lesions arising in the liver is broader than that of many other solid organs. However, this differential can be further refined depending on the type of fat (macroscopic vs intravoxel) and with the use of ancillary imaging findings. Radiologists must be aware of benign and malignant mimickers of common lesions.

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