Lesson 3B (Part 2) Flashcards
Are cystic neoplasms benign or malignant?
Both
- good patient history is important to help differentiate
What do the majority of pseudocysts have?
Cystic lesions
- > 75%
What are some imaging features to help with differential diagnosis?
CT and MRI are not reliable when charaterizing when small
- importance of US is to follow patients with cysts 3cm or less in diameter
What are high-risk features of cystic pancreatic lesions? (5)
- Symptomatic Patients
- Growth on serial examinations
- Diameter >3cm
- Internal soft tissue
- Mural or septal thickening
Where are simple cysts rare?
In the pancreas
What are examples of inherited diseases with a high prevalence of cysts? (2)
- Polycystic Kidney Disease
- ADPKD - Von Hippel-Lindau Disease
- VHL
Von Hippel-Lindau Disease
Is a connective tissue disorder
What does multiple simple pancreatic cysts suggest?
VHL
What are 3 lesions associated with VHL?
- Serous cystic neoplasm
- Pancreatic endocrine tumors
- Ductal adenocarcinoma
Why do you use colour doppler on a benign cyst in the pancreatic tail?
To differentiate from a tortuous splenic artery
What are cystic tumours normally?
Benign or low grade malignancies
Are mucinous tumours often benign or malignant?
Malignant
Who has a great risk for mucinous tumours?
Older individuals
What is the most common cystic neoplasms in order of prevalence? (4)
- Serous cystic
- Intraductal papillary mucinous
- Mucinous cystic
- Solid pseudopapillary
What was serous cystic neoplasm previously known as?
Microcystic adenoma
Microcystic adenoma
Is a benign tumor that is more frequently found in women that most often occurs in the pancreatic head
Whats does serous cystic neoplasm look like sonographically?
- Myriad of tiny cysts
- too small to be resolved individually with US - Echogenic appearance
- due to multiple reflective wall interfaces - Posterior enhancement
- Fibrous pattern may be present
- Central calcification
- 30-50% of the time
IPMN
Intraductal papillary mucinous neoplasm
What are 3 other names for intraductal papillary mucinous neoplasm?
- Intraductal papillary mucinous tumor
- Intraductal mucin-hyperfunctioning neoplasm
- Ductectatic mucinous neoplasm
Where does IPMN arise from?
The pancreatic ducts
- head region usually
Who does IPMN affect more?
The elderly
- men and women equally
How does IPMN persist?
As acute pancreatitis
Why does IPMN persist as acute pancreatitis?
Due to mucin being secreted into ducts
- duct dilation and sometimes
Mucin travels to ampulla of Vater
Is IPMN benign or malignant?
Can be either
What is often present in IPMN?
Adenocarcinoma
- 30-70% of the time
What is the hallmark on US for IPMN?
Prominent ductal dilation
How does mucin appear on US?
Similar to sludge
Who is mucinous cystic neoplasm more common in?
Perimenopausal women
Where does mucinous cystic neoplasm appear more common?
Pancreatic body & tail
What are the sonographic features of mucinous cystic neoplasm? (4)
- May be unilocular or multilocular
- Thick or thin wall
- May have septations
- thick or thin - Internal debris is common
How are mucinous cystic neoplasms best managed as?
Malignant lesions
