Characterization of Cystic Tumors of the Pancreas: CT Accuracy

Abstract

As patients with previous history of pancreatitis were excluded from the study, CT findings allowed correct characterization of only 60% of cystic pancreatic masses. Among the remaining 40%, 15-20% of the wrong diagnoses could not be corrected by means of CT, given the patterns shown by the tumors. In 20-25% of the cases, a nonspecific diagnosis of cystic mass was made.

Serous cystadenoma of the pancreas

“…Recent medical literature has reported the incidence of an accurate diagnosis of SCA based on imaging studies to vary from 27.2% to 77.7% [9][10][11] Of greater concern is the potential misdiagnosis of a malignant neoplastic mucinous cyst as an SCA, an event that was reported to occur in 7 of 28 patients in 1 study 9 and in 2 of 49 patients in another. 10 The high proportion of macrocystic SCA (24%), which is notoriously more difficult to diagnose, may explain the relatively low accuracy of cross-sectional imaging noted in the current study. It should also be noted that the current study, with a high percentage of surgically resected SCAs, was biased toward SCAs with an atypical imaging appearance.…”

Solid pseudopapillary neoplasm of the pancreas mimicking a pseudocyst of pancreas

“…This is because of the presence of haemorrhaging and necrosis, even when a thick capsule exists. 3,7 That is why it can be confused with pseudocyst of pancreas as in our case. Grossly e mostly the neoplasms present as large, round, solitary masses (average size 8e10 cm), and are often fluctuant.…”

“…Occasionally, the haemorrhagic-cystic changes involve almost the entire lesion so that the neoplasm may be mistaken for a pseudocyst. 6,7 The tumour wall may contain calcifications. Though unusual multicentric or extrapancreatic (mesocolonic, retroperitoneal, omental, hepatic) presentation have been reported, metastasis is rare.…”

Cystic Neoplasm of the Pancreas

“…Microcystic serous cystadenoma appears like a "honeycomb" with a typical central calcification named "central scar." However, less common macrocystic variants may be more difficult to differentiate from a mucinous tumor, with several studies having shown that CT is discriminatory in less than half of the cases [5,6]. When tomographic imaging is not able to provide a proper specific characterization, endoscopic ultrasound (EUS) and cyst fluid aspiration have been recommended as useful diagnostic techniques.…”