Pancreatic Cystic Lesion

Question 1

DDX for cystic pancreatic lesion

Answer 1

Serous cystoadenoma
Mucinous cystoadenoma
Intraductal papillary neoplasm
Solid pseudo papillary cyst
Pseudocyst
Cystic degeneration of solid tumor

Question 2

Cytological analysis (CEA, Amylase for the following lesions:
A) Serous cystadenoma
B) Mucinous cystadenoma
C) IPMN
D) Pseudocyst

Answer 2

A) CEA low, Amylase low
B) CEA high, Amylase low
C) CEA high, Amylase high
D) CEA low, Amylase high

Question 3

Radiological feature of serous cystadenoma

Answer 3

Central stellate scar

Microcystic/honeycombed lesion

Question 4

Radiological features of mucinous cystadenoma

Answer 4

Septated cystic lesion
Mostly in tail
Presence of ovarian like storm
lack of communication with ductal system
Peripheral eggshell appearance

Question 5

Which cystic neoplasms most fit with following demographics:

1) 70-80s grandma
2) 50-60s mother
3) 20-30s daughter

Answer 5

1) serous cystadenoma
2) mucinous cystic neoplasms
3) solid pseudopapillary neoplasm

Question 6

Indications for resection of pancreatic cystic lesions

Answer 6

Mucinous cystadenocarcinoma
Cystic neuroendocrine tumor
Symptomatic patients
selected IPMN
cysts with high risk stigmata

Question 7

Worrisome features in BD-IPMN

Answer 7

Clinical: pancreatitis
Imaging: 
Cyst > 3cm
Thickened/enhancing cyst wall
MD 5-9mm
Non-enhancing mural nodule
Abrupt change in PD with distal pancreatic atrophy

Question 8

Incidence of malignancy for:

1) MD-IPMN
2) BD-IPMN

Answer 8

1) 70%

2) 15%, >3cm 30%

Question 9

Risk factors for malignancy in BD-IPMN < 3cm

Answer 9

Solid components
PD >1cm
Lymphadenopathy

Question 10

Extrapancreatic malignancies in IPMN

Answer 10

gastric cancer (most common)
colorectal carcinoma (most common)
bile duct cancer
renal cell carcinoma
thyroid carcinoma
Lymphoma

Question 11

High risk stigmata features

Answer 11

Obstructive jaundice with cystic lesion at head of pancreas
Enhancing mural nodule >5mm
Main pancreatic duct >= 10mm