Pancreas Flashcards
Diseases that cause multiple pancreatic cysts
Von hippel lindau
Cystic fibrosis
What are high risk stigmata for IPMN/MCN according to tanaka criteria
Enhancing solid component
Main pancreatic duct 10mm +
Obstructive jaundice
What is groove pancreatitis?
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.
What imaging finding is pathognomonic of pancreatic serous cystadenoma?
Stellate scar with central calcification
What is the typical patient population for serous cystic tumor of the pancreas?
Elderly (mean age 65) non-hispanic white women
Typical imaging appearance of serous microcystic pancreatic adenoma?
Large (>5cm), solitary lobulated contour central stellate scar central calcifications (30%) honeycomb pattern >6 cysts, <2cm per cyst hypervascular
Why do some serous microcystic pancreatic adenomas appear solid on CT and ultrasound?
Because the cysts are too small to be visualized and instead we see the many septations. An MRI is required for further assessment.
Which cystic pancreatic tumor can you exclude if hemorrhage is present?
IPMN, they never contain hemorrhagic content.
What is the typical patient population for mucinous cystadenoma of the pancreas?
Middle age (mean 47y) women (99.7%) Do not make the diagnosis of mucinous cystic tumor in a man
Typical imaging appearance of mucinous cystadenoma of the pancreas?
Body and tail (>95%) cysts (<6 cysts, >2cm in size) large (mean 8.7cm) and solitary always encapsulated calcifications 15% mural nodules hypovascular
What are the cystic tumors of the pancreas that have a capsule? (4)
mucinous cystadenoma
SPEN
pseudocyst
neuroendocrine tumor
What is the typical patient population for solid pseudopapillary neoplasm of the pancreas?
young women (85%, age 25) no race and location predilection
What are imaging features of solid pseudopapillary neoplasm of the pancreas?
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
What is the typical patient population for intraductal papillary mucinous neoplasm?
older men (70%, mean 65y)
TRUE OR FALSE
In IPMN, the tumor is not visualized on imaging
True
We see the ductal dilatation secondary to mucin secretion, but the tumor itself is not visualized
TRUE OR FALSE
IPMN is the only pancreatic tumor that communicates with the main pancreatic duct
TRUE
How do you differentiate main duct IPMN from chronic pancreatitis?
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.
What are ACR recommendations for following cystic pancreatic tumors?
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
TRUE OR FALSE
Lymphadenopathy inferior to the renal vessels is typical in pancreatic adenocarcinoma
FALSE
It is atypical and in such cases lymphomatous involvement of the pancreas should be considered
what are the two encapsulated solid pancreatic tumors?
neuroendocrine tumor
PEComa (perivascular epitheloid cell tumor, sugar tumor)
What are the features of auto-immune pancreatitis?
sausage pancreas no ductal dilatation biliary strictures periductal enhancement segmental or diffuse signal intensity changes capsular enhancement
What is lipase hypersecretion syndrome?
Secondary to lipase secretion by an acinar cell carcinoma - 10% of cases (pancreas tumor):
subcutaneous fat necrosis
polyarthralgia - bone infarct
eosinophilia
What % of insulinomas are malignant?
10%
When assessing a multiloculated pancreatic cystic lesion, what are the criteria for microcystic vs macrocystic?
6 cysts or more measuring <2cm = microcystic
Less than 6 cysts measuring >2cm = macrocystic
