HPB: Pancreatic cystic lesions

Question 1

What are the types of neoplastic pancreatic cystic lesions? list five

Answer 1

Serous cystic neoplasms, Mucinous cystic neoplasms, IPMN, Solid pseudopapillary neoplasms, Cystic degeneration of solid pancreatic cancer (NETs or Adeno)

Each type has distinct characteristics and implications for treatment.

Question 2

What are the subtypes of Intraductal Papillary Mucinous Neoplasm (IPMN)?

Answer 2

Main duct, side branch, mixed

IPMN can vary significantly in behavior and management based on its subtype.

Question 3

What lesions make up 90% of cystic lesions of the pancreas?

Answer 3

Pancreatic pseudocyst

Question 4

What are the characteristics of patients with pancreatic pseudocysts?

Answer 4

Male aged 50-70
Background of pancreatitis

Question 5

What are the imaging appearances of pancreatic pseudocysts?

Answer 5

Hypovascular

Question 6

List two benign cystic lesions of the pancreas

Answer 6

Pancreatic pseudocyst
Serous cystadenoma

Question 7

List four neoplastic cystic lesions of the pancreas

Answer 7

Mucinous cystadenoma
Main duct IPMN
Branch duct IPMN
Solid pseudopapillary

Question 8

What are the characteristics of patients with serous cystadenoma?

Answer 8

60 - 70 yo
Female

Grandma

Question 9

What is difficult to differentiate from a serous cystadenoma?

Answer 9

Mucinous cystadenomas

Question 10

What are the characteristics of patients with mucinous cystadenomas?

Answer 10

40-50yo
Females
Do NOT communicate with main pancreatic duct
Produce mucin

Mother

Question 11

What are the characteristics of patients with main duct IPMN?

Answer 11

50-70yo
F=M

Question 12

What are the characteristics of patients with branch duct IPMN?

Answer 12

50-70yo
F=M

Question 13

What are the characteristics of patients with solid pseudopapillary neoplasms?

Answer 13

Young

Question 14

What is this lesion?

Answer 14

Serous cystadenoma

Question 15

What is this lesion?

Answer 15

Mucinous cystadenoma

Question 16

What is this lesion?

Answer 16

Main duct IPMN

Question 17

What is this lesion

Answer 17

CT serous cystadenoma

Question 18

What is this lesion?

Answer 18

CT mucinous cystadenoma

Question 19

What is this lesion?

What is this lesion

Answer 19

CT Main duct IPMN

Question 20

What is this lesion

Answer 20

CT side branch IPMN

Question 21

What is this lesion

Answer 21

CT solid pseudopapillary

Question 22

What are the imaging characteristics of a pancreatic pseudocyst?

Answer 22

Avascular

Question 23

What are the imaging characteristics of a mucinous cystadenoma

Answer 23

Single - large
In body and tail of pancreas
Peripheral calcifications

Question 24

What are the imaging characteristics of main duct IPMN?

Answer 24

Diffuse pancreatic duct dilatation >5mm
(size/septae/mural nodules/calcifications/duct communication)

Question 25

What are the imaging characteristics of side branch/branch duct IPMN?

Answer 25

Grape like No dilated main pancreatic duct

Question 26

What are the imaging characteristics of solid pseudopapillary pancreatic lesions?

Answer 26

Well circumscribed Necrosis Haemorrhage Mix of solids and cystic mass

Question 27

What are the bloods results might be consistent with a pseudocyst?

Answer 27

Amylase raised

Question 28

What are the bloods/ EUS/FNA results consistent with a serous cystadenoma?

Answer 28

CEA normal No mucin

Question 29

What are the bloods EUS/FNA results consistent with a mucinous cystadenoma?

Answer 29

CEA raised Amylase raised Ovarian stroma - tall columnar (ddx from ipmn)

Question 30

What are the EUS/FNA results consistent with a main duct ipmn

Answer 30

Amylase raised CEA raised No ovarian stroma

Question 31

What are the bloods/ EUS/FNA results consistent with a side branch IPMN?

Answer 31

Amylase raised CEA raised No ovarian stroma

Question 32

What are the bloods/ EUS/FNA results consistent with a solid pseudopapillary lesion?

Answer 32

Bloody

Question 33

What is the treatment for a serous cystadenoma?

Answer 33

Resect if: symptomatic >4cm solid component irregular wall rapid growth calcification in the wall

Question 34

What is the treatment for mucinous cystadenoma?

Answer 34

Resect (distal pancreatectomy +/- splenectomy)

Question 35

What is the treatment for a main duct IPMN?

Answer 35

Resect

Question 36

What is the management of a side branch IPMN?

Answer 36

Resect if >3cm symptomatic solid component irregular wall calcification in the wall rapid growth

Question 37

What is the management of a solid pseudopapillary lesion?

Answer 37

Resect - most common reason for inability to resect is vascular invasion

Question 38

What is the prognosis for patients with serous cystadenomas?

Answer 38

Good long term prognosis Median growth rate is 5mm/year

Question 39

What is the prognosis for patients with mucinous cystadenomas?

Answer 39

If cystadenoma - no long term follow up if cystadenocarcinoma, needs follow up

Question 40

What is the prognosis for patients with main duct IPMNs?

Answer 40

Worrisome features: Size >3cm Mural nodes <5mm Pancreatic duct 5-9mm Rapid growth >5mm/2yr

Question 41

What is the prognosis for patients with branch duct IPMN?

Answer 41

High risk stigmata Cyst HOP + jaundice Mural node >5mm Pancreatic duct >1cm