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Abdomen > Pancreas > Flashcards

Pancreas Flashcards

1
Q

Diseases that cause multiple pancreatic cysts

A

Von hippel lindau

Cystic fibrosis

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2
Q

What are high risk stigmata for IPMN/MCN according to tanaka criteria

A

Enhancing solid component

Main pancreatic duct 10mm +

Obstructive jaundice

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3
Q

What is groove pancreatitis?

A

focal chronic pancreatitis affecting the groove between the head of the pancreas, the duodenum and the common bile duct.
Typically seen in males with history of EtoH abuse, peak incidence 40-50years of age.

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4
Q

What imaging finding is pathognomonic of pancreatic serous cystadenoma?

A

Stellate scar with central calcification

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5
Q

What is the typical patient population for serous cystic tumor of the pancreas?

A

Elderly (mean age 65) non-hispanic white women

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6
Q

Typical imaging appearance of serous microcystic pancreatic adenoma?

A 
Large (>5cm), solitary
lobulated contour
central stellate scar
central calcifications (30%)
honeycomb pattern
>6 cysts, <2cm  per cyst
hypervascular
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7
Q

Why do some serous microcystic pancreatic adenomas appear solid on CT and ultrasound?

A

Because the cysts are too small to be visualized and instead we see the many septations. An MRI is required for further assessment.

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8
Q

Which cystic pancreatic tumor can you exclude if hemorrhage is present?

A

IPMN, they never contain hemorrhagic content.

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9
Q

What is the typical patient population for mucinous cystadenoma of the pancreas?

A 
Middle age (mean 47y) women (99.7%)
Do not make the diagnosis of mucinous cystic tumor in a man
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10
Q

Typical imaging appearance of mucinous cystadenoma of the pancreas?

A 
Body and tail (>95%)
cysts (<6 cysts, >2cm in size)
large (mean 8.7cm) and solitary
always encapsulated
calcifications 15%
mural nodules
hypovascular
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11
Q

What are the cystic tumors of the pancreas that have a capsule? (4)

A

mucinous cystadenoma
SPEN
pseudocyst
neuroendocrine tumor

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12
Q

What is the typical patient population for solid pseudopapillary neoplasm of the pancreas?

A 
young women (85%, age 25)
no race and location predilection
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13
Q

What are imaging features of solid pseudopapillary neoplasm of the pancreas?

A 
large solitary
Capsule
Hemorrhage
solid and cystic areas
calcification 30%

The presence of hemorrhage in an encapsulated pancreatic lesion in a young woman is almost always a SPEN

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14
Q

What is the typical patient population for intraductal papillary mucinous neoplasm?

A

older men (70%, mean 65y)

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15
Q

TRUE OR FALSE

In IPMN, the tumor is not visualized on imaging

A

True

We see the ductal dilatation secondary to mucin secretion, but the tumor itself is not visualized

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16
Q

TRUE OR FALSE

IPMN is the only pancreatic tumor that communicates with the main pancreatic duct

A

TRUE

17
Q

How do you differentiate main duct IPMN from chronic pancreatitis?

A

The pancreatic dilatation in chronic pancreatitis is secondary to areas of stenosis along the pancreatic duct, whereas with IPMN there is no stenosis.

However, main duct IPMN can eventually lead to chronic pancreatitis secondary to outflow obstruction.

18
Q

What are ACR recommendations for following cystic pancreatic tumors?

A

If <2cm: 1 year (stop if stable)
If 2-3cm: 6 months for 2 years then yearly (IPMN), 1 yr (indet), 2 yr (serous)
>3cm: 6 months or resection

MRI or ultrasound are best

19
Q

TRUE OR FALSE

Lymphadenopathy inferior to the renal vessels is typical in pancreatic adenocarcinoma

A

FALSE

It is atypical and in such cases lymphomatous involvement of the pancreas should be considered

20
Q

what are the two encapsulated solid pancreatic tumors?

A

neuroendocrine tumor

PEComa (perivascular epitheloid cell tumor, sugar tumor)

21
Q

What are the features of auto-immune pancreatitis?

A 
sausage pancreas
no ductal dilatation
biliary strictures
periductal enhancement
segmental or diffuse signal intensity changes
capsular enhancement
22
Q

What is lipase hypersecretion syndrome?

A

Secondary to lipase secretion by an acinar cell carcinoma - 10% of cases (pancreas tumor):

subcutaneous fat necrosis
polyarthralgia - bone infarct
eosinophilia

23
Q

What % of insulinomas are malignant?

A

10%

24
Q

When assessing a multiloculated pancreatic cystic lesion, what are the criteria for microcystic vs macrocystic?

A

6 cysts or more measuring <2cm = microcystic

Less than 6 cysts measuring >2cm = macrocystic

Abdomen (5 decks)

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