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Pancreatic Cyst Neoplasms > Pancreatic Cyst Questions > Flashcards

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
Q

% of neoplastic cysts that are MCNs

A

23.40%

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26
Q

MCN presentation

A

Usually incidental, may present with mass effect

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27
Q

General fluid characteristics of MCNs

A

Viscous/Mucin

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28
Q

Amylase and CEA level of MCNs

A

Low amylase, CEA >400

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29
Q

CT characteristics of MCNs

A

Well circumscribed, macrocystic, peripheral Ca++ highly specific. May have internal septations

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30
Q

EUS characteristics of MCNs

A

Unilocular cyst with possible internal septations. No ductal communication

31
Q

Characteristics in MCNs concerning for malignancy

A

> 5cm, solid component, Ca++, CEA >800, K ras mutation, malignant cytology

32
Q

FU for MCNs

A

< 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
Q

Surgical indications for MCNs

A

Resect al lesions depending on comorbidities as these degenerate to malignancy over time

34
Q

Surgical procedure for MCNs

A

Complete excision/formal resection. Lap > Open

35
Q

Prognosis for MCNs

A

Excellent, benign/in situ disease has 100% survival

36
Q

Malignant MCN potential

A

5 year survival 40%

37
Q

Demographics of IPMNs

A

Age 60-70s, Gender M=F

38
Q

Cytology/Histology of IPMNs

A

Columnar cells, atypia, + Mucin

39
Q

Distribution of IPMNs throughout pancreas

40
Q

Do IPMNs have malignant potential?

41
Q

% of IPMNs that are malignant

A

Main duct dz: 50%

Side branch dz: 20%

42
Q

Genetic mutations associated with IPMNs

A

PIK3CA, MUC, K-ras mutations

43
Q

% of neoplastic cysts that are IPMN

44
Q

IPMNs increase the risk for what other malignancies?

A

Breast, prostate and GI malignancies

45
Q

Presentation of IPMNs

A

Usually pain, ? Mild recurrent pancreatitis, incidental, rare mass effect

46
Q

General fluid analysis of IPMNs

A

Viscous/Mucin

47
Q

Amylase and CEA level in IPMNs

A

Amylase: Elevated

CEA > 192

48
Q

CT imaging characteristics of IPMN

A

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
Q

EUS findings for IPMN

A

Main duct: Main PD dilation with mucin

Side branch: Cystic lesion without main PD dilation

50
Q

Characteristics in IPMN concerning for malignancy

A

ﾳ 3 cm, ﾳ 1 cm duct, intramural nodules, malignant cytology

51
Q

FU imaging for IPMNs

A

< 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
Q

Surgical indications for IPMNs main duct-type

A

Resect all lesions depending on comorbidities

53
Q

Surgical indications for IPMNs side branch-type

A
  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
Q

Surgical procedure for IPMNs

A

Formal resection, lap > open. Get frozens to ensure - margins

55
Q

IPMN prognosis for benign lesions

A

Excellent. Benign/in-situ disease: 100% survival.

56
Q

What % of benign IPMNs recur?

57
Q

IPMN prognosis for malignant lesions

A

5 year survival 60%. 10 year 50%. Multi-centric disease likely to recur.

58
Q

Pseudopapilary Cystic Neoplasm demographics

A

Age: 20s, gender: F (89%)&raquo_space;M

59
Q

Cytology/Histology of pseudopapillary cystic neoplasms

A

Papillary formations, glycogen

60
Q

Distribution of peudopapillary cystic neoplasms in the pancreas

61
Q

Do pseudopancreaticcystic neoplasms have malignant potential?

62
Q

What % of pseudpapillary cystic neoplasms are malignant?

63
Q

What genetic mutations increase the risk for pseudopapillary cystic neoplasms?

A

Beta-catenin

64
Q

% of neoplastic cysts that are a result of pseudopapillary cystic neoplasms?

65
Q

Presentation of pseudopapillary cystic neoplasms?

A

Pain or mass effect

66
Q

Fluid analysis of psuedopapillary cystic neoplasms

A

Necrotic debris

67
Q

Amylase and CEA level of pseudopapillary cystic neoplasms?

68
Q

CT findings of pseudopapillary cystic neoplasms

A

Encapsulated tumor with central hypodensities secondary to necrosis/hemorrhage

69
Q

EUS findings of pseudopapillary cystic neoplasms

A

Mixed features of solid/cystic mass. Fluid due to necrosis or hemorrhage. No ductal communication

70
Q

Characteristics on imaging concerning for malignancy for pseudopapillary cystic neoplasms

71
Q

FU imaging for pseudopapillary cystic neoplasms

72
Q

Surgical indications for pseudopapillary cystic neoplasms

A
  1. Symptoms

2. Cannot exclude malignancy

73
Q

Surgical procedure for pseudopapillary cystic neoplasms

A

Formal resection, Lap > open

74
Q

Prognosis for pseudopapillary cystic neoplasms

A

Excellent - benign/institute disease 100 survival

Pancreatic Cyst Neoplasms (1 decks)

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