Pancreas

Question 1

What pancreatic tumor is most common in MEN 1?

Answer 1

Gastrinoma

Question 2

What are the radiologic characteristics of a pheochromocytoma?

Answer 2

High attenuation with hyperintensity on MRI

Question 3

What characterizes a pancreatic tumor as locally advanced?

Answer 3

> 180 abutment of the SMA

Question 4

Describe the amylase and CEA findings of MCN, serous cystic neoplasms, solid pseudopapillary tumors and IPMN

Answer 4

Serous: low CEA and amylase; cells are glycogen rich

Mucinous: high CEA, low amylase; ovarian type stroma, stains mucin +

Pseudopapillary: low CEA and amylase with necrotic cells

IPMN: Moderate CEA, high amylase, mucin producing columnar epithelium; stains mucin +

Question 5

What are worrisome features of pancreatic cysts? (7)

Answer 5

cyst >3 cm
enhancing mural nodule
thickened cyst wall
main duct 5-9 mm
lymphadenopathy
Increased CA 19-9 (>37)
Growth rate >5mm over 2 years

Question 6

What are high-risk features of pancreatic cysts? (3)

Answer 6

Jaundice
Enhancing solid component
Main duct >1 cm

Question 7

What is the difference between WOPN and pseudocyst?

Answer 7

Pseudocyst has a homogenous fluid density collection and is usually extra pancreatic

WOPN is heterogenous w/varying degrees of loculation

Question 8

What is the imaging modality of choice for suspected pancreas divisum?

Answer 8

Secretin-enhanced MRCP

Question 9

What is the surveillance of ampullary adenomas w/out high grade dysplasias?

Answer 9

Endoscopy 6 months post op then q1 year for 2 years and then q5 years