Cystic Lesions of the Pancreas: Radiologic-Endosonographic Correlation

Abstract

Cystic lesions of the pancreas are relatively common findings at cross-sectional imaging; however, classification of these lesions on the basis of imaging features alone can sometimes be difficult. Complementary evaluation with endoscopic ultrasonography and fine-needle aspiration may be helpful in the diagnosis of these lesions. Cystic lesions of the pancreas may range from benign to malignant and include both primary cystic lesions of the pancreas (including intraductal papillary mucinous neoplasms, mucinous cystic neoplasms, serous cystadenomas, pseudocysts, and true epithelial cysts) and solid neoplasms undergoing cystic degeneration (including neuroendocrine tumors, solid pseudopapillary neoplasms, and, rarely, adenocarcinoma and its variants). Familiarity with the imaging features of these lesions and the basic treatment algorithms is essential for radiologists, as collaboration with gastroenterologists and surgeons is often necessary to obtain an early and accurate diagnosis.

Prevalence of pancreatic cystic neoplasms on imaging exams: association with signs of malignancy risk

“…It can have a multilocular appearance, with a solid component, accompanied by ductal dilation and parenchyma atrophy (19,21) . Mucinous cystadenomas present as unilocular cystic lesions, with walls well differentiated from the rest of the pancreatic parenchyma, and can be divided into multiple compartments by thin septa, with or without thick contents (mucin).…”

“…In rare cases, the cystic component can be identified by imaging examination and is associated with necrosis or retention of pancreatic secretion due to ductal obstruction (21) . Albeit uncommon, cystadenocarcinoma has an exceptionally high mortality rate, making it one of the most common causes of cancer mortality in developed countries.…”

Endoscopic ultrasound guided brush/fine‐needle aspiration cytology: A 15‐month study

“…EUS‐FNA is a sensitive (81%–98%) and highly specific (99%–100%) modality for the diagnosis of pancreatic lesions. It represents a recent addition to the armamentarium for the diagnosis of pancreatic diseases . As compared with percutaneous FNA, EUS guided lowers the risk of peritoneal seeding from pancreatic cancer .…”

Cystic pancreatic neuroendocrine tumors: To date a diagnostic challenge

“…Some of them are benign lesions and can be safely managed expectantly, and some others are pre-malignant or malignant lesions and generally require surgical resection at diagnosis or close follow up. Decisions regarding surgical treatment of cystic lesions of the pancreas are based on the potential risk of malignancy or the presence of symptoms [67]. On the other hand, surgical resection of all pancreatic lesions, particularly those located in the pancreatic head, is associated with a significant morbidity [68].…”