Mucinous cystic neoplasms of the pancreas: high-resolution cross-sectional imaging features with clinico-pathologic correlation

Abstract

MCN size (> 8.5 cm) and volume are the only features on MDCT/MR imaging that correlate with high-grade dysplasia/carcinoma. The average growth rate for MCNs is slow at approximately 4 mm per year.

Multiple-line Chemotherapy for a Patient with Unresectable Mucinous Cystic Neoplasm of the Pancreas

“…MCN is histologically diagnosed based on the existence of an ovarian-type stroma (10,11). If a surgical specimen is not available, the clinical diagnosis is made based on the characteristics of a unilocular or septated macrocystic lesion without connection to the pancreatic duct, enhancing mural nodules on CECT, and wall thickening (12,13). A cytological analysis after endoscopic ultrasound-guided fine-needle aspiration can detect malignant cystic lesions.…”

Radiological Workup of Cystic Neoplasms of the Pancreas

“…The ovarian stromal elements differentiate MCNs from IPMNs, which have stromal elements of pancreatic ductal origin. They usually present as solitary, unilocular, well-circumscribed round or lobular cysts (about 80%) that can range from small to large dimensions (1-36 cm), mostly in the pancreatic body and tail (up to 75%) [33,34]. Internal septa may be seen which can create a multilocular appearance.…”

“…The defining and characteristic histopathologic feature of MCNs is the presence of ovarian-type stroma akin to that observed in biliary cystadenomas [32]. Hence, MCNs almost exclusively occur in females, typically in their middle age [33]. The ovarian stromal elements differentiate MCNs from IPMNs, which have stromal elements of pancreatic ductal origin.…”

“…Peripheral curvilinear or eggshell calcifications may be seen in the wall or internal septa in up to 25% of cases and are better depicted on CT [2,26,30]. MCNs may grow slowly over time, at an average rate of 4 mm per year [33,34]. …”

“…Differential considerations are inflammatory cystic lesions (discriminators: clinical history of pancreatitis, in the absence of a proper clinical history; however, these lesions may be radiologically indistinguishable) and oligocystic serous cystadenoma. In contrast to serous cystadenoma, the septa in MCNs are located peripherally and in a disorganized fashion which may give a ‘pseudonodular' appearance [33]. …”