Imaging of cystic pancreatic lesions

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Radiographics article review

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PowerPoint Presentation:

Dr. Varun Babu Dr. Varun

Introduction :

Introduction Dr. Varun Pseudocysts – MC cystic lesions of pancreas All other lesion account only for 15% Thin slice CT, MRCP, endoscopic US Clinical history, imaging findings and tissue diagnos is will help improve diagnosis

Pancreatic pseudocyst:

Pancreatic pseudocyst Dr. Varun Localized amylase rich fluid collections located within pancreatic tissue or adjacent to pancreas, surrounded by fibrous wall that does not possess an epithelial lining. CT: round or oval fluid collection with thin barely perceptible wall, or thick wall that enhances Often develop as a complication of acute or chronic pancreatitis, trauma or surgery

Pancreatic pseudocyst:

Dr. Varun Careful evaluation of clinical history important for diagnosis of pseudocyst After identifiable acute pancreatitis Acute incident superimposed on chronic pancreatitis Uncertain or no previous clinical history of pancreatitis Classic post inflammatory pseudocyst Develops during 4-6 weeks Follow conservatively if <6cm in size or asymptomatic Unilocular more common Smooth thin wall or thick wall of uniform thickness Infection, hemorrhage, rupture, obstruction of other viscera Pancreatic pseudocyst

PowerPoint Presentation:

Dr. Varun Secondary infection – dreaded complication Drainage by radiology, endoscopy, or surgical decompression

PowerPoint Presentation:

Dr. Varun

PowerPoint Presentation:

Dr. Varun

PowerPoint Presentation:

Dr. Varun

PowerPoint Presentation:

Dr. Varun

PowerPoint Presentation:

Dr. Varun

PowerPoint Presentation:

Dr. Varun

PowerPoint Presentation:

Dr. Varun

PowerPoint Presentation:

Dr. Varun

Pseudocyst in chronic pancreatitis:

Pseudocyst in chronic pancreatitis Dr. Varun Alcoholism, hyperlipidemia , hyperparathyroidism, trauma, chronic obstruction of PD Distinct history of acute pancreatitis lacking. Often detected incidentally Diagnosis made easy with associated findings – parenchymal calcification, ductal stones, ductal dilatation and atrophy of parenchyma Without these psedudocyst difficult to distinguish from IPMT

Pseudocyst in the absence of an insult:

Pseudocyst in the absence of an insult Dr. Varun Smaller than symptomatic cysts Possible cystic neoplasm needs to be ruled out Especially in the absence of leading history, USG, CT or endoscopic US guided aspiration is necessary or at least follow up should be recommended.

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Dr. Varun

Cystic neoplasms:

Cystic neoplasms Dr. Varun Uncommon, but important since they are increasingly being detected. Serous cystadenoma , mucinous cystic neoplasm, IPMT, solid and papillary epithelial neoplasm, cystic islet cell tumor

Serous cystadenoma:

Serous cystadenoma Dr. Varun Microcystic cystadenoma Females >60yrs Non specific abdominal pain or weight loss Multiple cysts ranging from 2mm to 2cm; size ranging from 1.4 to 27cm

Serous cystadenoma:

Dr. Varun Central stellate scar with calcification Internally cyst has a honeycomb appearance comparable with innumerable cysts USG – solid echogenic mass due to interfaces produced by the numerous cysts CT - may appear solid, depending on size and amount of fibrous tissue Serous cystadenoma

PowerPoint Presentation:

Dr. Varun

PowerPoint Presentation:

Dr. Varun

Serous cystadenoma:

Dr. Varun Asymptomatic serous cystadenomas do not require excision <2cm likely to be serous cystadenoma Macrocystic or oligocystic variants, difficult to distinguish from mucinous cystadenoma Pancreatic head location, lobulated contour, lack of wall enhancement favor macrocystic serous cystadenoma Serous cystadenoma

Mucinous cystic neoplasms:

Mucinous cystic neoplasms Dr. Varun MC cyst tumors of the pancreas Cysts lined by tall columnar mucin producing cells Unilocular / multilocular Solid papillary excrescences protrude from the wall into the interior of the tumors

Mucinous cystic neoplasms:

Dr. Varun Multiple enhancing septations and intramural nodules are typical Peripheral calcification seen in 10-25% cases Round to oval with smooth external surface. Occasionally communication with PD is present Range from benign to malignant, though can’t be proved on imaging and all need to be excised. Mucinous cystic neoplasms

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Dr. Varun

PowerPoint Presentation:

Dr. Varun

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Dr. Varun

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Dr. Varun

Intraducal papillary mucinous tumor:

Intraducal papillary mucinous tumor Dr. Varun Papillary proliferation of ductal epithelium and production of mucin Cystic dilatation of main or side branch duct containing thick mucoid secretions. Non specific abdominal symptoms, sometimes hyperamylasemia Elderly, men

Intraducal papillary mucinous tumor:

Dr. Varun Classified into Main duct type Branch duct type Combined type Side branch duct type commonly mistaken for mucinous cyst tumor or pseudocyst Typical location – uncinate process, grapelike locular appearance, with communication with duct at ERCP. Intraducal papillary mucinous tumor

Intraducal papillary mucinous tumor:

Dr. Varun ERCP – modality of choice for diagnosis Depict bulging ampulla of vater , mucin pouring from the papilla, communication btw pancreatic duct and cystic cavity MRCP, endoscopic US and thin slice CT may depict communication Intraducal papillary mucinous tumor

PowerPoint Presentation:

Dr. Varun

PowerPoint Presentation:

Dr. Varun

PowerPoint Presentation:

Dr. Varun

PowerPoint Presentation:

Dr. Varun

Solid and papillary epithelial neoplasm:

Solid and papillary epithelial neoplasm Dr. Varun Solid and pseudopapillary tumors Papillary and cystic tumors Solid-cystic tumors Low malignant potential with favorable prognosis Young women, Asian, black Nausea, vomiting, abdominal pain/fullness

Solid and papillary epithelial neoplasm:

Dr. Varun Large, well circumscribed and slow growing mass Purely cystic to completely solid, surrounded by thick well defined rim. Solid and papillary epithelial neoplasm

PowerPoint Presentation:

Dr. Varun

PowerPoint Presentation:

Dr. Varun

PowerPoint Presentation:

Dr. Varun

PowerPoint Presentation:

Dr. Varun

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