Lesson 3B (Part 2)

Question 1

Are cystic neoplasms benign or malignant?

Answer 1

Both

- good patient history is important to help differentiate

Question 2

What do the majority of pseudocysts have?

Answer 2

Cystic lesions

- > 75%

Question 3

What are some imaging features to help with differential diagnosis?

Answer 3

CT and MRI are not reliable when charaterizing when small

- importance of US is to follow patients with cysts 3cm or less in diameter

Question 4

What are high-risk features of cystic pancreatic lesions? (5)

Answer 4

1. Symptomatic Patients
2. Growth on serial examinations
3. Diameter >3cm
4. Internal soft tissue
5. Mural or septal thickening

Question 5

Where are simple cysts rare?

Answer 5

In the pancreas

Question 6

What are examples of inherited diseases with a high prevalence of cysts? (2)

Answer 6

1. Polycystic Kidney Disease
   - ADPKD
2. Von Hippel-Lindau Disease
   - VHL

Question 7

Von Hippel-Lindau Disease

Answer 7

Is a connective tissue disorder

Question 8

What does multiple simple pancreatic cysts suggest?

Answer 8

VHL

Question 9

What are 3 lesions associated with VHL?

Answer 9

1. Serous cystic neoplasm
2. Pancreatic endocrine tumors
3. Ductal adenocarcinoma

Question 10

Why do you use colour doppler on a benign cyst in the pancreatic tail?

Answer 10

To differentiate from a tortuous splenic artery

Question 11

What are cystic tumours normally?

Answer 11

Benign or low grade malignancies

Question 12

Are mucinous tumours often benign or malignant?

Answer 12

Malignant

Question 13

Who has a great risk for mucinous tumours?

Answer 13

Older individuals

Question 14

What is the most common cystic neoplasms in order of prevalence? (4)

Answer 14

1. Serous cystic
2. Intraductal papillary mucinous
3. Mucinous cystic
4. Solid pseudopapillary

Question 15

What was serous cystic neoplasm previously known as?

Answer 15

Microcystic adenoma

Question 16

Microcystic adenoma

Answer 16

Is a benign tumor that is more frequently found in women that most often occurs in the pancreatic head

Question 17

Whats does serous cystic neoplasm look like sonographically?

Answer 17

1. Myriad of tiny cysts
   - too small to be resolved individually with US
2. Echogenic appearance
   - due to multiple reflective wall interfaces
3. Posterior enhancement
4. Fibrous pattern may be present
5. Central calcification
   - 30-50% of the time

Question 18

IPMN

Answer 18

Intraductal papillary mucinous neoplasm

Question 19

What are 3 other names for intraductal papillary mucinous neoplasm?

Answer 19

1. Intraductal papillary mucinous tumor
2. Intraductal mucin-hyperfunctioning neoplasm
3. Ductectatic mucinous neoplasm

Question 20

Where does IPMN arise from?

Answer 20

The pancreatic ducts

- head region usually

Question 21

Who does IPMN affect more?

Answer 21

The elderly

- men and women equally

Question 22

How does IPMN persist?

Answer 22

As acute pancreatitis

Question 23

Why does IPMN persist as acute pancreatitis?

Answer 23

Due to mucin being secreted into ducts
- duct dilation and sometimes
Mucin travels to ampulla of Vater

Question 24

Is IPMN benign or malignant?

Answer 24

Can be either

Question 25

What is often present in IPMN?

Answer 25

Adenocarcinoma

- 30-70% of the time

Question 26

What is the hallmark on US for IPMN?

Answer 26

Prominent ductal dilation

Question 27

How does mucin appear on US?

Answer 27

Similar to sludge

Question 28

Who is mucinous cystic neoplasm more common in?

Answer 28

Perimenopausal women

Question 29

Where does mucinous cystic neoplasm appear more common?

Answer 29

Pancreatic body & tail

Question 30

What are the sonographic features of mucinous cystic neoplasm? (4)

Answer 30

1. May be unilocular or multilocular
2. Thick or thin wall
3. May have septations
   - thick or thin
4. Internal debris is common

Question 31

How are mucinous cystic neoplasms best managed as?

Answer 31

Malignant lesions