Abstract
Background
Our purpose was to correlate the imaging findings of small cystic pancreatic lesions to the incidence of growth on follow-up imaging and their pathologic diagnoses.
Methods
CT images for 159 patients with cystic pancreatic lesions were retrospectively evaluated and lesions were assessed for size, number, connection to the main pancreatic duct (MPD), MPD dilatation, and any presence of loculation, wall irregularity, thick septations, or solid components. A total of 86 patients had follow-up imaging with time periods of less than 6 months (n = 21), 6–12 months (n = 22), 1–2 years (n = 14), and greater than 2 years (n = 29). Lesion histology was available in 20 patients.
Results
Lesions with pathologic correlation proved to be: side branch intraductal papillary mucinous neoplasm or tumor (IPMT) (n = 5), combined type IPMT (n = 4), nonmucinous cyst (n = 4), chronic pancreatitis (n = 2), and reactive atypia with nonmucinous fluid (n = 1), combined type IMPT with foci of adenocarcinoma (n = 1), mucinous adenocarcinoma (n = 2), and nonmucinous adenocarcinoma (n = 1). Lesions with solid components were significantly more likely to grow and be malignant (P < 0.05). The presence of MPD dilatation was more common in patients with combined type IPMTs or malignancies. No other factors were predictive of malignancy.
Conclusions
Solid components are predictive of malignancy, and MPD dilatation should prompt consideration of surgery. Other cystic lesions can be followed.
Similar content being viewed by others
References
Karla MK, Maher MM, Mueller PR, et al. (2003) State-of-the-art imaging of pancreatic neoplasms. Br J Radiol 76:857–865
Horton KM (2002) Multidetector CT and three-dimensional imaging of the pancreas: state of the art. J Gastrointest Surg 6:126–128
Nino-Murcia M, Tamm EP, Charnsangavej C, et al. (2003) Multidetector-row helical CT and advanced postprocessing techniques for the evaluation of pancreatic neoplasms. Abdom Imaging 28:366–377
Kloppel G, Kosmahl M (2001) Cystic lesions and neoplasms of the pancreas: the features are becoming clearer. Pancreatology 1:648–655
Kloppel G (2000) Pseudocysts and other non-neoplastic cysts of the pancreas. Semin Diagn Pathol 17:7–15
Kimura W, Nagai H, Kuroda A, et al. (1995) Analysis of small cystic lesions of the pancreas. Int J Pancreatol 18:197–206
Kimura W, Makuuchi M (1999) Operative indications for cystic lesions of the pancreas with malignant potential—our experience. Hepatogastroenterology 46:483–491
Kimura W, Sasahira N, Yoshikawa T, et al. (1996) Duct ecstatic type of mucin-producing tumor of the pancreas—new concept of pancreatic neoplasia. Hepatogastroenterology 43:692–709
Tollefson MK, Libsch KD, Sarr MG, et al. (2003) Intraductal papillary mucinous neoplasm: did it exist prior to 1980? Pancreas 26:e55–e58
Procacci C, Carbognin G, Biasiutti C, et al. (2001) Intraductal papillary mucinous tumors of the pancreas: spectrum of CT and MR findings with pathologic correlation. Eur Radiol 11:1939–1951
Lim FH, Lee G, Oh YL (2001) Radiologic spectrum of intraductal papillary mucinous tumor of the pancreas. Radiographics 21:323–340
Taouli B, Vilgrain V, Vullierme M, et al. (2000) Intraductal papillary mucinous tumors of the pancreas: helical CT with histopathologic correlation. Radiology 217:757–764
Fitzgerald TL, Smith AJ, Ryan M, et al. (2003) Surgical treatment of incidentally identified pancreatic masses. Can J Surg 46:413–418
Choi BS, Kim TK, Kim AY, et al. (2003) Differential diagnosis of benign and malignant intraductal papillary mucinous tumors of the pancreas: MR cholangiopancreatography and MR angiography. Korean J Radiol 4:157–162
Wiesenauer CA, Schmidt CM, Cummings OW, et al. (2003) Preoperative predictors of malignancy in pancreatic intraductal papillary mucinous neoplasms. Arch Surg 138:610–618
Sugiyama M, Izumisato Y, Abe N, et al. (2003) Predictive factors for malignancy in intraductal papillary-mucinous tumours of the pancreas. Br J Surg 90:1244–1249
Bernard P, Scoazec J, Joubert M, et al. (2002) Intraductal papillary-mucinous tumors of the pancreas: predictive criteria of malignancy according to pathological examination of 53 cases. Arch Surg 137:1274–1278
Yamaguchi K, Sugitani A, Chijiiwa K, et al. (2001) Intraductal papillary-mucinous tumor of the pancreas: assessing the grade of malignancy from natural history. Am Surg 67:400–406
Irie H, Yoshimitsu K, Aibe H, et al. (2004) Natural history of pancreatic intraductal papillary mucinous tumor of branch duct type: follow-up study by magnetic resonance cholangiopancreatography. J Comput Assist Tomogr 28:117–122
Rubin DL, Desser TS (2003) Radbank: building an integrated data warehouse for radiology teaching, process improvement, and research. Radiology 229:S607
Sugiyama M, Atomi Y (1998) Intraductal papillary mucinous tumors of the pancreas: imaging studies and treatment strategies. Ann Surg 288:685–691
Lim JH, Lee G, Oh YL (2001) Radiologic spectrum of intraductal papillary mucinous tumor of the pancreas. Radiographics 21:323–340
Traverso LW, Peralta EA, Ryan JA, et al. (1998) Intraductal neoplasms of the pancreas. Am J Surg 175:426–432
Handrich SJ, Hough DM, Fletcher JG, et al. (2005) The natural history of the incidentally discovered small simple pancreatic cyst: follow-up and clinical implications. AJR 184:20–23
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kirkpatrick, I., Desser, T.S., Nino-Murcia, M. et al. Small cystic lesions of the pancreas: clinical significance and findings at follow-up. Abdom Imaging 32, 119–125 (2007). https://doi.org/10.1007/s00261-006-9080-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-006-9080-5