Unit 8 Pancreatic Pathology- Congenital Anomalies (Elie)

How many types of Cystic lesions of the pancreases are there?

2 types

What are the two types of cystic lesions of the pancreas?

• True cysts

• Pseudocysts- most common

  • Unilocular or multilocular

True cysts can either be ________ or ________

Congenital or acquired

What are true cysts description?

• Microscopic sacs

• Multiple- no septations

Where do true cysts arise from?

Arise from within the gland

What do true cyst contain?

Pancreatic enzymes

Acquired cysts are:

• Pseudocysts – most common

• Retention cysts

• Parasitic cysts

• Neoplastic cysts

What is a congenital cyst?

• Abnormal development of pancreatic ducts

• Multiple

What is the measurement of congenital cysts?

3-5 cm

Autosomal Dominant Polycystic Disease is an extrarenal cyst most commonly found where?

In the liver

Where can an Autosomal Dominant Polycystic Disease, extrarenal cyst also be found?

• In the pancreas

• Other organs

What is Von Hippel-Lindau Syndrome?

• Autosomal dominant condition with formation of tumors and cysts in many different parts of the body

US findings for Von Hippel-Lindau Syndrome?

• Well-defined mass with thick fluid

• Calcifications

• Single or Multiple

• Vary in size from microscopic to several cm

Cystic Fibrosis is also what disease of the pancreas?

Fibrocystic Disease

What is Fibrocystic Disease of the pancreas?

• Hereditary Disorder of Endocrine Glands

• Dilated Acini & Ducts

• Acini replaced by fibrous tissue

What does fibrocystic disease of the pancreas look like overall?

• Nodular and firm pancreas

• Hyperechoic (^ echogenicity)

• Well-defined mass with serous fluid

What are the 4 classifications of Cystic Pancreatic Neoplasms?

• Serous Cystic Neoplasms

• Mucinous Cystic Neoplasms

• Intraductal Papillary Mucinous Neoplasms

• Solid Pseudopapillary Neoplasms

What is this image showing?

Cystic Pancreatic Neoplasms

What is a Serous Cystadenoma also called?

Microcystic Adenoma Cystadenoma

Is serous cystadenoma a benign or malignant disease?

Benign disease

A serous cystadenoma is considered:

Rare

Serous Cystadenoma is more common in:

Females > Males

Serous Cystadenomas are tiny cysts with 60% in the _____ and ____; and 30 % in the ______.

Body and tail; head

US appearance for a Serous Cystadenoma:

• Similar to pseudocysts – cystic, solid or echogenic

• May have internal septa

• Thick walls

• Single or multiple

What is this image showing?

Cystadenoma

What is this in the image above?

Cystadenoma

A mucinous Cystadenoma/ Cystadenocarcinoma is also called?

Macrocystic Adenocarcinoma

What is a Mucinous Cystadenoma?

• Rare, slow-growing neoplasm

• Significant malignant potential

• Arises from the ducts

• Large cyst w/wo septations

With a Mucinous Cystadenoma, it arises more in the body or tail with the tail equaling what percentage?

60%

A mucinous cystadenoma will have:

pain/palpable mass

What are the concurrent diseases for a mucinous cystadenoma?

• Diabetes

• Biliary calculous

• Arterial hypertension

What is this image showing?

Mucinous Cystadenoma

US appearance for Mucinous Cystadenoma:

• Well-circumscribed

• Smooth-surfaced

• Thin or thick walled

• Unilocular or multilocular

• Cystic lesions

• Variable sizes

• Thick mucinous fluid

• Internal septations or mural nodules

• Pancreatic calcifications frequent

When scanning a mucinous cystadenoma what should you also evaluate for?

Mets

What is this image showing?

Mucinous Cystadenoma/Cystadenocarcinoma/Macrocystic Adenocarcinoma

What is an Intraductal Papillary Mucinous Neoplasm?

• A form of mucinous cystic neoplasm

Where does an Intraductal Papillary Mucinous Neoplasm originate from?

From main pancreatic duct or branches

Intraductal Papillary Mucinous Neoplasms are classified as:

• Slow-growing

• Benign to malignant

What are the symptoms, lab values, and prevalence for an Intraductal Papillary Mucinous Neoplasm?

• Abdominal pain

• Elevated Amylase

• Most prominent in elderly men + women

What is this image showing?

Intraductal Papillary Mucinous Neoplasm

A Solid Pseudopapillary Neoplasm is most common in?

Young women

A Solid Pseudopapillary Neoplasm has a low incidence of what?

Malignancy

What are the symptoms for a Solid Pseudopapillary Neoplasm?

• Usually asymptomatic

  • Abdominal pain

  • N/V

  • Weight loss

US findings for a Solid Pseudopapillary Neoplasm:

• Frequently seen in tail

• Heterogeneous

• Solid & cystic components

• Smaller in size

  • MRI is more specific

This diagram show?

Different classifications of a pancreatic cyst