Intraductal Papillary Mucinous Tumors of the Pancreas. Comparison of helical CT and MR imaging

Fukukura, Yoshihiko; Fujiyoshi, Fumito; Hamada, Hiroyuki; Takao, Sonshin; Aikou, Takashi; Hamada, Nobuo; Yonezawa, Suguru; Nakajo, Masayuki

doi:10.1034/j.1600-0455.2003.00111.x

Cited by 34 publications

(37 citation statements)

References 23 publications

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“…Large tumor size and marked dilation of the MPD in branch duct IPMNs have also been reported to be associated with malignancy [14,[20][21][22][23][24][25], but this conclusion was not confirmed by other studies [4,18,24,[26][27][28]. In the present study, both maximal MPD diameter and size of the entire cystic lesion were larger in malignant than in benign lesions, but this difference was not statistically significant.…”

Section: Discussioncontrasting

confidence: 54%

“…Thus, minimally invasive or noninvasive imaging methods for diagnostic and preoperative examinations would be advantageous for patients and surgeons. Fukukura et al [11] reported that papillary proliferation ( > _ 3 mm) was detected equally well by helical CT and MRCP. However, in our experience, the CT and MRCP techniques often detect only a thickened septum and have difficulty detecting intramural nodules due to the limited spatial resolution of the typically small, flat tumor.…”

Section: Discussionmentioning

confidence: 99%

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Utility of Multidetector Row CT in Diagnosing Branch Duct IPMNs of the Pancreas Compared with MR Cholangiopancreatography and Endoscopic Ultrasonography

et al. 2010

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Section: Discussioncontrasting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Utility of Multidetector Row CT in Diagnosing Branch Duct IPMNs of the Pancreas Compared with MR Cholangiopancreatography and Endoscopic Ultrasonography

et al. 2010

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“…3). MR imaging is used increasingly because of its ability to determine if there is involvement of the main pancreatic duct [24]. Ultrasonography whether performed transabdominally or intraoperatively is generally not helpful [25].…”

Section: Diagnostic Methodsmentioning

confidence: 99%

Cystic pancreatic lesions: Can we diagnose them accurately what to look for? FNA marker molecular analysis resection, surveillance, or endoscopic treatment?

Brugge

2006

Endoscopy

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IntroductionCystic lesions of the pancreas consist of a spectrum of benign, pre-malignant, and malignant malignancies. In the past, cystic neoplasms of the pancreas were thought to be relatively rare, but the widespread use of cross sectional imaging has dramatically increased ability to detect these lesions. Although the vast majority of pancreatic cysts are discovered incidentally, large or invasive lesions may produce sufficient symptoms to cause the patient to seek medical attention.Cystic neoplasms are often confused or misdiagnosed as pseudocysts or peripancreatic collections of inflammatory fluid that may morphologically mimic cystic neoplasms. Furthermore, the presenting symptoms of pseudocysts may be identical to the symptoms associated with cystic neoplasms.Cystic neoplasms of the pancreas are traditionally organized by the type of lining epithelium since this feature dominates the risk of malignancy and management [1] ( Table 1). There are three types of mucinous lesions, benign mucinous cystadenomas, malignant mucinous cystic lesions, and intra-ductal papillary mucinous neoplasms (IPMNs). The non-mucinous lesions include serous cystadenomas, cystic endocrine tumors and other rare lesions. PrevalenceThe prevalence of pancreatic cysts has been examined with autopsy examinations of the pancreas in adults without known pancreatic disease. The prevalence of pancreatic cysts found at autopsies in Japan was approximately 73 of 300 autopsies (24.3 %) cases [2]. The prevalence of cysts increased with increasing age of the patient. The cysts were located throughout the pancreatic parenchyma and were not related to chronic pancreatitis. The epithelium of the cysts displayed a spectrum of neoplastic change, including atypical hyperplasia (16.4 %); carcinoma in situ (3.4 %).

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“…The multidetector row CT is about 80% accurate for discriminating a nonmucinous from a mucinous cyst, and for predicting malignancy. 20 MRI and MRCP have inherently superior soft tissue contrast over CT that facilitates 20,[37][38][39] Despite these advances in CT and MRI, reliable image diagnosis of pancreatic cysts is not always possible because of considerable morphological overlap in various cyst subtypes, especially small (<3 cm) cysts. As such, a classification system of cyst morphology has recently been proposed for assessing the risk of malignancy.…”

Section: Role Of Imaging In Pancreas Cyst Evaluationmentioning

confidence: 99%

Pancreatic cysts

Pitman

Lewandrowski

Shen

et al. 2010

Cancer Cytopathology

125

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Preoperative diagnosis of pancreatic cysts benefits from integrating the clinical, radiological, and cytological features. As patient management algorithms evolve to increasingly nonsurgical options, accuracy in distinguishing mucinous from nonmucinous and benign from malignant mucinous cysts is important. This review focuses on pseudocysts, serous cystadenomas, intraductal papillary mucinous neoplasms (IPMNs), and mucinous cystic neoplasms. Patients with pseudocysts almost always present with pancreatitis and are usually medically managed. Radiological studies reveal a unilocular cyst mostly in the pancreatic tail. Cyst fluid is thin, with high amylase but low carcinoembryonic antigen (CEA) levels. DNA mutations are absent. Serous cystadenomas are benign and do not require resection. Patients are usually asymptomatic and have microcystic or macrocystic masses anywhere in the pancreas. Cytology is frequently nondiagnostic. CEA and amylase levels are low. DNA analysis may reveal loss of heterozygosity (LOH) at 3p if associated with Von Hippel-Lindau disease. Neoplastic mucinous cysts are highly variable in their presentation. Most are resected. Mucinous cystic neoplasms typically arise in the body or tail of the pancreas of middle-aged women and demonstrate a septated cyst without dilatation of the main pancreatic duct. Branch duct IPMNs are more common in the pancreatic head of elderly men. Main duct dilatation correlates with main duct or combined type IPMN. Both types of mucinous cysts produce variable amounts of mucin. Cytologically nonmalignant but atypical epithelial cells, even when scant, are an indication of a high risk for malignancy. High CEA level supports a mucinous cyst, as do KRAS mutation and good quality DNA levels. KRAS mutation and multiple LOH support malignancy.

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Intraductal Papillary Mucinous Tumors of the Pancreas. Comparison of helical CT and MR imaging

Abstract: MR imaging was equal or slightly superior to thin-section helical CT in the evaluation of intraductal papillary mucinous tumors.

Cited by 34 publications

References 23 publications

Utility of Multidetector Row CT in Diagnosing Branch Duct IPMNs of the Pancreas Compared with MR Cholangiopancreatography and Endoscopic Ultrasonography

Utility of Multidetector Row CT in Diagnosing Branch Duct IPMNs of the Pancreas Compared with MR Cholangiopancreatography and Endoscopic Ultrasonography

Cystic pancreatic lesions: Can we diagnose them accurately what to look for? FNA marker molecular analysis resection, surveillance, or endoscopic treatment?

Pancreatic cysts

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