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Pancreatic Cyst Questions Flashcards

1
Q

What age do serous cystadenomas usually present?

A

70s

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2
Q

What is the gender preference of serous cyst adenomas?

A

F (70%) >M

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3
Q

Histology/cytology of serous cyst adenomas

A

Cuboidal cells, glycogen rich

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4
Q

Distribution of serous cyst adenomas throughout the pancreas

A

Even

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5
Q

Is there malignant potential of SCAs?

A

No (<1%)

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6
Q

Genetic mutations that increase risk of SCAs

A

VHL mutation

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7
Q

Serous cyst adenomas account for what % of neoplastic cysts?

A

NA

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8
Q

Presentation of SCAs

A

Usually incidental, may present with mass effect

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9
Q

General fluid characteristics of SCAs

A

Thin/serous

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10
Q

Amylase level in SCAs

A

Low

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11
Q

CEA level in SCAs

A

Low (< 5 ng/mL)

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12
Q

Imaging characteristics of SCAs

A

Well circumscribed, Micro cysts (60%), Macro/Honey comb (20%), Mixed (15%) cystic. Fibrous central scarring with calcifications are pathognomonic (30%)

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13
Q

On imaging, is there a connection between the cyst and pancreatic duct for SCAs?

A

No communication

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14
Q

Characteristics in SCAs that are concerning for malignancy

A

Incidental, slow growing tumor (average growth 0.6 cm/year)

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15
Q

FU imaging for SCAs

A

< 2cm: yearly
2-5 cm: q6 months
ﾳ 4 cm: q3-6 month
Once stable for ﾳ 2 years, increase time interval

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16
Q

Surgical indications for SCAs

A
  1. Symptoms

2. ﾳ 4 cm

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17
Q

Surgical procedure for SCAs

A

Due to size, formal resection is often required

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18
Q

Prognosis for SCAs

A

Excellent - benign condition

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19
Q

Give the demographics of MCNs

A

Age: 50s
Gender: F (98%)&raquo_space; M

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20
Q

Cytology/histology of MCNs

A

Columnar cells, papillary sheets, ovarian-like stroma, + Mucin

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21
Q

Distribution of MCNs in the pancreas

A

Body/Tail (95%)

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22
Q

Do MCNs have malignant potential?

A

Yes

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23
Q

What % of MCNs are malignant?

A

30%

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24
Q

Genetic mutations that increase risk for MCNs

A

K-ras, p53 mutations

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25
% of neoplastic cysts that are MCNs
23.40%
26
MCN presentation
Usually incidental, may present with mass effect
27
General fluid characteristics of MCNs
Viscous/Mucin
28
Amylase and CEA level of MCNs
Low amylase, CEA >400
29
CT characteristics of MCNs
Well circumscribed, macrocystic, peripheral Ca++ highly specific. May have internal septations
30
EUS characteristics of MCNs
Unilocular cyst with possible internal septations. No ductal communication
31
Characteristics in MCNs concerning for malignancy
> 5cm, solid component, Ca++, CEA >800, K ras mutation, malignant cytology
32
FU for MCNs
< 1 cm: Yearly 1-2 cm: Q 6 mo ﾳ 2 cm: Q 3-6 mo Once stable for ﾳ 2 years, increase time interval
33
Surgical indications for MCNs
Resect al lesions depending on comorbidities as these degenerate to malignancy over time
34
Surgical procedure for MCNs
Complete excision/formal resection. Lap > Open
35
Prognosis for MCNs
Excellent, benign/in situ disease has 100% survival
36
Malignant MCN potential
5 year survival 40%
37
Demographics of IPMNs
Age 60-70s, Gender M=F
38
Cytology/Histology of IPMNs
Columnar cells, atypia, + Mucin
39
Distribution of IPMNs throughout pancreas
Even
40
Do IPMNs have malignant potential?
Yes
41
% of IPMNs that are malignant
Main duct dz: 50% | Side branch dz: 20%
42
Genetic mutations associated with IPMNs
PIK3CA, MUC, K-ras mutations
43
% of neoplastic cysts that are IPMN
23.60%
44
IPMNs increase the risk for what other malignancies?
Breast, prostate and GI malignancies
45
Presentation of IPMNs
Usually pain, ? Mild recurrent pancreatitis, incidental, rare mass effect
46
General fluid analysis of IPMNs
Viscous/Mucin
47
Amylase and CEA level in IPMNs
Amylase: Elevated | CEA > 192
48
CT imaging characteristics of IPMN
CT Main duct: Main pancreatic duct dilation (0.5 mm) with micr/macrocysts (20% with multiple) CT Side Branch duct: cyst communicates with PD without main duct dilation (20% multiple).
49
EUS findings for IPMN
Main duct: Main PD dilation with mucin | Side branch: Cystic lesion without main PD dilation
50
Characteristics in IPMN concerning for malignancy
ﾳ 3 cm, ﾳ 1 cm duct, intramural nodules, malignant cytology
51
FU imaging for IPMNs
< 1 cm: Yearly 1-2 cm: Q 6 mo ﾳ 2 cm: Q 3-6 mo Once stable for ﾳ 2 years, increase time interval Ensure up to date on mammography, colonoscopy, and PSA. Consider upper endoscopy
52
Surgical indications for IPMNs main duct-type
Resect all lesions depending on comorbidities
53
Surgical indications for IPMNs side branch-type
1. Symptoms 2. ﾳ 3 cm(if stable, may be OK to observe in elderly) 3. Duct size > 7 mm 4. Intramural nodules/Wall thickening 5. ﾳ 2 cm & increasing in size 6. Gastric or PB epithelium
54
Surgical procedure for IPMNs
Formal resection, lap > open. Get frozens to ensure - margins
55
IPMN prognosis for benign lesions
Excellent. Benign/in-situ disease: 100% survival.
56
What % of benign IPMNs recur?
20%
57
IPMN prognosis for malignant lesions
5 year survival 60%. 10 year 50%. Multi-centric disease likely to recur.
58
Pseudopapilary Cystic Neoplasm demographics
Age: 20s, gender: F (89%) >>M
59
Cytology/Histology of pseudopapillary cystic neoplasms
Papillary formations, glycogen
60
Distribution of peudopapillary cystic neoplasms in the pancreas
Even
61
Do pseudopancreaticcystic neoplasms have malignant potential?
Yes
62
What % of pseudpapillary cystic neoplasms are malignant?
10-15%
63
What genetic mutations increase the risk for pseudopapillary cystic neoplasms?
Beta-catenin
64
% of neoplastic cysts that are a result of pseudopapillary cystic neoplasms?
3.40%
65
Presentation of pseudopapillary cystic neoplasms?
Pain or mass effect
66
Fluid analysis of psuedopapillary cystic neoplasms
Necrotic debris
67
Amylase and CEA level of pseudopapillary cystic neoplasms?
Low/low
68
CT findings of pseudopapillary cystic neoplasms
Encapsulated tumor with central hypodensities secondary to necrosis/hemorrhage
69
EUS findings of pseudopapillary cystic neoplasms
Mixed features of solid/cystic mass. Fluid due to necrosis or hemorrhage. No ductal communication
70
Characteristics on imaging concerning for malignancy for pseudopapillary cystic neoplasms
NA
71
FU imaging for pseudopapillary cystic neoplasms
NA
72
Surgical indications for pseudopapillary cystic neoplasms
1. Symptoms | 2. Cannot exclude malignancy
73
Surgical procedure for pseudopapillary cystic neoplasms
Formal resection, Lap > open
74
Prognosis for pseudopapillary cystic neoplasms
Excellent - benign/institute disease 100 survival

Pancreatic Cyst Neoplasms (1 decks)

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