DIAGNOSIS OF NEOPLASTIC PANCREATIC CYSTS

Abstract

Preoperative diagnostic studies of 11 patients with neoplastic pancreatic cyst (2 with intraductal adenocarcinoma (IDAC), 2 with intraductal adenoma (IDA), 1 with mucinous cystadenocarcinoma (MCAC), 3 with mucinous cystadenoma (MCA), 1 with serous cystadenoma, 1 with solid and cystic tumor, 1 with ductal cell adenocarcinoma associated with a cyst) are described. All patients with IDAC and IDA were males and had lesions at the head of the pancreas, while all patients with MCAC and MCA were females and had lesions at the body or tail of the pancreas. Most patients with neoplastic pancreatic cysts had septums or mural nodules in the cysts by ultrasonography (US) and computed tomography (CT). The evidence of septums or mural nodules was useful in differentiating neoplastic cysts from non-neoplastic cysts. Endoscopic retrograde pancreatographic findings of IDAC and IDA were characterized by widely-opened orifice of the major papilla with mucous excretion and diffusely-dilated main pancreatic duct with filling defects by mucin. Angiographic findings of malignant neoplastic pancreatic cysts tended to show encasement of the extrapancreatic arteries and obstruction of the splenic vein.
These results suggest that the evidence of septums or mural nodules in the pancreatic cysts by US or CT is useful in differentiating neoplastic cysts from non-neoplastic cysts, and the evidence of encasement or obstruction of the extrapancreatic arteries or the portal veins by angiography indicates malignant cysts.