Pancreatic Cysts



Pancreatic Cysts


Brooke R. Jeffrey, MD

Michael P. Federle, MD, FACR





Key Facts


Terminology



  • Congenital, true, or epithelial pancreatic cyst



    • Refers to nonneoplastic, noninflammatory cysts


Imaging



  • Usually quite small (< 2 cm)


  • Round or oval shape, smooth thin wall, absence of internal complexity


  • Usually unilocular


  • Solitary or multiple (associated with cystic syndromes)


  • Syndromes account for most nonneoplastic cysts



    • von Hippel-Lindau disease


    • Autosomal dominant polycystic kidney (ADPKD)


Top Differential Diagnoses



  • Pancreatic pseudocyst


  • Pancreatic serous cystadenoma


  • Mucinous cystic pancreatic tumor


  • Pancreatic IPMN


  • Lymphangioma (mesenteric cyst)


  • Cystic islet cell tumor


Clinical Issues



  • “Simple” cyst ≤ 2 cm in asymptomatic adult is rarely of any clinical significance



    • Can follow with imaging, especially in elderly


  • Treatment: Clinical surveillance


  • Complete resection if endoscopic US or cyst aspiration suggests tumor


Diagnostic Checklist



  • Endoscopic US with needle aspiration is most accurate means of diagnosis







(Left) Axial CECT shows a water density cystic lesion image in the pancreatic body. (Right) Endoscopic ultrasound in the same patient shows an anechoic cyst image with a small mural nodule image. Needle aspiration yielded clear fluid with borderline elevated CEA and cellular atypia. This was interpreted as equivocal for malignancy, and a laparoscopic distal pancreatectomy was performed. The excised specimen showed an epithelial lining and was classified as a true cyst of the pancreas.






(Left) Gross pathologic specimen of a resected tail of the pancreas shows a small cystic lesion image with a smooth wall and no internal complexity or tumor nodularity. (Right) Histologic analysis of the pathologic specimen in the same patient shows benign epithelium lining the wall of this simple epithelial cyst image. Note the adjacent normal pancreatic parenchyma image.



TERMINOLOGY


Synonyms



  • Congenital, true, or epithelial pancreatic cyst


Definitions



  • Refers to nonneoplastic, noninflammatory cysts


IMAGING


General Features



  • Best diagnostic clue



    • Simple-appearing cyst with no septa or mural nodularity in patients with no history of pancreatitis


  • Size



    • Usually quite small; giant cyst as large as 15 cm in diameter reported


  • Morphology



    • Round or oval shape, smooth thin wall, absence of internal complexity


    • Usually unilocular


    • Solitary or multiple (associated with cystic syndromes)


Radiographic Findings



  • ERCP: No connection between cyst and duct


CT Findings



  • Round lesion with water density contents


  • Thin, imperceptible wall


MR Findings



  • Hypointense on T1WI; hyperintense on T2WI


Ultrasonographic Findings



  • Anechoic; usually devoid of internal echoes

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Sep 20, 2016 | Posted by in GENERAL RADIOLOGY | Comments Off on Pancreatic Cysts

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