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ECR 2019 / C-3472
Pancreatic cystic neoplasms – clinical, radiological and pathological findings
Congress: ECR 2019
Poster No.: C-3472
Type: Educational Exhibit
Keywords: Pathology, Neoplasia, Cysts, Imaging sequences, Education, MR, CT, Pancreas, Abdomen
Authors: M. D. L. Costa1, A. L. Proenca2, R. Martins2, N. C. Ribeiro1, A. Figueiredo1, F. Andre1; 1Lisboa/PT, 2Lisbon/PT
DOI:10.26044/ecr2019/C-3472

Findings and procedure details

Fig. 1
References: Centro Hospitalar Universitário de Lisboa Central - Lisboa/PT
Fig. 2
References: Centro Hospitalar Universitário de Lisboa Central - Lisboa/PT
Fig. 3
References: Centro Hospitalar Universitário de Lisboa Central - Lisboa/PT
Fig. 4
References: Centro Hospitalar Universitário de Lisboa Central - Lisboa/PT
Fig. 5
References: Centro Hospitalar Universitário de Lisboa Central - Lisboa/PT
Fig. 6
References: Centro Hospitalar Universitário de Lisboa Central - Lisboa/PT
Fig. 7
References: Centro Hospitalar Universitário de Lisboa Central - Lisboa/PT
Fig. 8
References: Centro Hospitalar Universitário de Lisboa Central - Lisboa/PT
Fig. 9
References: Centro Hospitalar Universitário de Lisboa Central - Lisboa/PT
Fig. 10
References: Centro Hospitalar Universitário de Lisboa Central - Lisboa/PT
Fig. 11
References: Centro Hospitalar Universitário de Lisboa Central - Lisboa/PT
Fig. 12
References: Centro Hospitalar Universitário de Lisboa Central - Lisboa/PT
Fig. 13
References: Centro Hospitalar Universitário de Lisboa Central - Lisboa/PT
Fig. 14
References: Centro Hospitalar Universitário de Lisboa Central - Lisboa/PT
Fig. 15
References: Centro Hospitalar Universitário de Lisboa Central - Lisboa/PT
Fig. 16
References: Centro Hospitalar Universitário de Lisboa Central - Lisboa/PT
Fig. 17
References: Centro Hospitalar Universitário de Lisboa Central - Lisboa/PT

 

  • CASE REPORT 1

- Female, 73 years old.

- Clinical information: Incidentalomas found in the study of chronic liver disease.

 

Fig. 18: Computed tomography. Two cysts: the biggest in the tail measuring 13mm (longest axis), and the other in the body, measuring 7mm (longest axis). Main pancreatic duct dilated (5mm), somewhat irregular, with abrupt caliper reduction and without unequivocal definition of macroscopic focal lesion. Dilatation of secondary ducts coexists.
References: Centro Hospitalar Universitário de Lisboa Central - Lisboa/PT

 

Fig. 19: MRI. Cyst located in the tail - anatomically contiguous with the main pancreatic duct. Cyst located in the body - apparent anatomical continuity with secondary duct. Main pancreatic duct dilated (6mm), with abrupt reduction and without unequivocal definition of macroscopic focal lesion. 
References: Centro Hospitalar Universitário de Lisboa Central - Lisboa/PT

 

Fig. 20: Pathology. The cyst is linned by mucinous epithelium with foci of high grade dysplasia. The morphological and immunohistochemical features were of the pancreatobilliary subtype.
References: Centro Hospitalar Universitário de Lisboa Central - Lisboa/PT

 

  • Diagnosis: Mixed type  intraductal papillary mucinous neoplasm.
  • Indication for surgery: Relative.

 

 

  • CASE REPORT 2

- Male, 78 years old

 

- Clinical information: Incidentaloma on CT, by surveillance of ascending aortic aneurysm.

 

Fig. 25: Magnetic resonance imaging. Two microcysts at the transition body/tail. Cystic expression in the uncinate process, with slightly lobulated contour, possibly constituted by small septations that present minimal contrast uptake (difficult valorization by the small dimensions), measuring 40mm (long axis). Main pancreatic duct dilated on proximal segment (6mm).
References: Centro Hospitalar Universitário de Lisboa Central - Lisboa/PT

 

Fig. 26: Magnetic Resonance Cholangiopancreatography.
References: Centro Hospitalar Universitário de Lisboa Central - Lisboa/PT

 

Fig. 27: Magnetic Resonance Cholangiopancreatography. Red arrow: cysts; blue arrow: communication with main pancreatic duct; green arrow: main pancreatic duct dilated.
References: Centro Hospitalar Universitário de Lisboa Central - Lisboa/PT

 

Fig. 28: Pathology. IPMN with areas of intestinal (A and B) and pancreatobilliary (C and D) differentiation.
References: Centro Hospitalar Universitário de Lisboa Central - Lisboa/PT

 

  • Diagnosis: Branch duct intraductal papillary mucinous neoplasm.
  • Indication for surgery: Relative.

 

 

  • CASE REPORT 3

- Female, 81 years old, caucasian

- Clinical information: Asymptomatic; Incidental pancreatic lesion.

 

Fig. 23: Computed tomography. Single lobulated pancreatic lesion, with multiple microcysts, measuring 50mm x 40mm x 70mm, located in the head/body transition. Main pancreatic duct with normal caliper.
References: Centro Hospitalar Universitário de Lisboa Central - Lisboa/PT

 

Fig. 24: Pathology. Multilocular cystic lesion. The cells are cuboid with clear/pale cytoplasm.
References: Centro Hospitalar Universitário de Lisboa Central - Lisboa/PT

 

  • Diagnosis: Serous Cystic Neoplasm.
  • Indication for surgery: No.

 

 

  • CASE REPORT 4

- Female, 34 years old, caucasian

- Clinical information: Abdominal “tight feeling” in the upper quadrants, with irradiation to the back and to the left upper limb.

 

 

Fig. 21: Computed tomography. Single pancreatic cystic lesion, apparently unilocular, located in the tail, measuring 13 x 9 x 9 cm (L x AP xT). The wall is almost imperceptible and the content is homogeneous. No evidence of septa or solid component with contrast uptake. Main pancreatic duct not dilated.
References: Centro Hospitalar Universitário de Lisboa Central - Lisboa/PT

 

  • MRI comfirm absence of communication between cystic lesion and main pancreatic duct (images unavailable in the Picture archiving and communication system.)

 

Fig. 22: Pathology. The cyst is linned by mucinous epithelium with low grade dysplasia. Beneath the epithelium there is ovarian type stroma (positivity with progesterone receptors).
References: Centro Hospitalar Universitário de Lisboa Central - Lisboa/PT

 

  • Diagnosis: Mucinous Cystic Neoplasm.
  • Indication for surgery: Yes.

 

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