E1831. Mother, Daughter, Grandmother: Cystic Pancreatic Masses and Their Diagnosis and Management
Authors
Amanda Ferguson;
University of California Davis Medical Center
Michael Larson;
University of California Davis Medical Center
Background
Cystic pancreatic lesions are increasingly identified secondary to the rise in cross sectional imaging performed, both CT and MRI. Familiarity with the most common differential can raise both resident and attending comfort in making diagnosis and management recommendations. The main differential for cystic pancreatic lesions can be broken down into two large categories: mucinous or serous masses. Within these broad categories, the most common lesions include intraductal papillary mucinous neoplasms (IPMN), mucinous cystic neoplasms (MCN), serous cystic neoplasms (SCN) and solid pseudopapillary neoplasms (SPN). Additional masses also include cystic neuroendocrine tumors as well as cystic metastatic disease. The demographics of the patients affected by some of these lesions have given them the nicknames of “Mother” (MCN), “Grandmother” (SCN) and “Daughter” (SPN) lesions. Specific management recommendations varies and stratification based on certain risk factors help determine which lesions should be followed with imaging, biopsied or surgically resected. Some determining factors include the size of mass, interval growth, serum markers (including CA 19-9), associated pancreatic ductal dilation, and presence of any solid component. Using the imaging characteristics and demographics, appropriate differential and recommendations can be made for each specific lesion of concern.
Educational Goals / Teaching Points
Review the common imaging appearances of pancreatic cystic masses: IPMN, MCN, SPN, and SCN. Discussion of a few less common cystic neoplasms involving the pancreas. Case based review of relevant imaging findings of several pancreatic masses. Evaluation of management recommendations for cystic pancreatic masses including imaging follow up guidelines, biopsy recommendations and resection recommendations.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Certain pancreatic cystic lesions tend to have a classic location and appearance. Differentials can be aided by the location, such as head or tail of the pancreas, and things such as the relationship with the pancreatic duct, such as IPMN commonly have a visible ductal connection. Commonly masses are initially identified with CT and then subsequent follow up is done with MRI secondary to the lack of radiation.
Conclusion
Many different cystic pancreatic masses exist, each with their own characteristic imaging features and patient populations. Recognizing key demographic information as well as common imaging features is important to formulate a differential and make best management decisions. Key imaging features include unilocular or multicystic lesions, the presence and location of calcifications, the presence of enhancing nodules. Additional information such as pancreatic duct size, serum CA 19-9 levels, and lesion size are also important to evaluate. Knowing to recognize the key imaging features will allow an appropriate differential and help narrow management decisions.
