Differential diagnosis of cystic tumors of the pancreas by endoscopic ultrasonography

Abstract

The characteristics of cystic tumors of the pancreas revealed by EUS are useful for their differential diagnosis.

Pancreatic cystic lesions: How endoscopic ultrasound morphology and endoscopic ultrasound fine needle aspiration help unlock the diagnostic puzzle

“…The cystic component can be classified "with microcystic area" or "without microcystic area". The microcystic area is defined as an area where small (less than 2-3 mm each) cysts aggregate (usually more than 6 cysts) separated by thin-walled septa, producing a honeycomb-like appearance [36] . The contour can be round (or ovoid), lobulated or irregular.…”

“…Visualization of the microcystic area within the cyst, located either at the centre of the cyst ( Figure 1A) or next to a macrocystic area [36] ( Figure 1B) or in the internal septa of the lesions [39] ( Figure 1C), is very typical of these lesions. The thin internal septa are hypervascular on Doppler [40] .…”

“…The best modality for depicting this aspect is EUS. The microcystic area is present in about 85% of SCNs and is highly accurate in the specific diagnosis of these lesions [36] . A central stellate scar (sunburst) [38] , sometimes calcified, is pathognomonic but is seen in 20%-30% of cases on MDCT but only in 11% of cases with EUS [39] .…”

“…The capsule is usually poor developed and there is often a poor distinction between the tumor and the surrounding pancreatic parenchyma [37,39,41] . These lesions usually have lobulated contours [36] ( Figure 1C).…”

Endoscopic Ultrasonography in Management of Cystic Disease of the Pancreas

“…Mucinous cystadenoma (MCA) is usually present in the body and tail of the pancreas as a well-circumscribed, rounded, anechoic cyst without any communication with the pancreatic duct. Branch duct IPMN has a similar appearance to MCA but it is not rounded, occasionally multicystic with communication with the pancreatic duct [39]. In some occasions, MCA cannot be differentiated from branch duct IPMN if the communication with the pancreatic duct is not clear.…”