Pancreatic ductal adenocarcinoma with intratumoral cystic lesions on MRI: correlation with histopathological findings

Abstract

ABSTRACT. The purpose of this study was to evaluate intratumoral cystic lesions of pancreatic ductal adenocarcinoma (PDAC) depicted on MRI, and to correlate these cystic lesions with their histopathological findings. This study included 12 patients (7 males and 5 females; mean age, 59 years) with intratumoral cystic lesions of PDAC detected on a retrospective MRI review. We reviewed the histopathological findings of the cystic lesions within PDACs and analysed the MRI findings, focusing on the appearance of the intratumoral cystic lesions, i.e. the size, number, margin and intratumoral location, and on the ancillary findings of PDAC, i.e. peripancreatic infiltration, upstream pancreatic duct dilatation and distal parenchymal atrophy. Intratumoral cystic lesions were classified as neoplastic mucin cysts (n57, 58%) or cystic necrosis (n55, 42%) according to the histopathological findings; they ranged in greatest dimension from 0.5 cm to 3.4 cm (mean, 1.7 cm). Seven patients had only one cystic lesion each, while the remaining five had multiple cystic lesions. Most of the neoplastic mucin cysts had smooth margins (n56, 86%) and eccentric locations (n56), whereas most cystic necroses had irregular margins (n54, 80%) and centric locations (n54). The most common ancillary findings of PDAC were peripancreatic infiltration, distal pancreatic atrophy and upstream pancreatic duct dilatation (92%, 75% and 58%, respectively). The intratumoral cystic lesions of PDACs on MRI were classified as either neoplastic mucin cysts with smooth margins and eccentric locations or cystic necroses with irregular margins and centric locations. Pancreatic cancer is the fifth leading cause of cancerrelated death in both men and women and is responsible for 5% of all cancer-related deaths in the United States [1]. Despite the advances in surgical techniques, as well as the major improvements in chemotherapy and radiotherapy protocols, the prognosis of pancreatic ductal adenocarcinoma (PDAC) usually implies a 1-year survival rate of ,20% and a 5-year survival rate of ,5% [2].PDAC typically presents as an irregular solid tumour with a scirrhous character resulting from a prominent desmoplastic reaction. However, recent studies have shown that PDAC may be accompanied by cystic changes within or adjacent to the mass, and that the incidence of PDAC with cystic changes ranges from ,1% to 8% [3,4]. Radiologists should be familiar with PDACs with cystic changes as they may resemble more common cystic pancreatic lesions, such as pseudocysts, intraductal papillary mucinous neoplasms (IPMNs), solid pseudopapillary tumours and non-functioning islet cell tumours, all of which are managed differently and usually have better patient survival rates [5][6][7].Many studies have discussed the radiological appearance of PDAC accompanied by cystic lesions [6][7][8][9][10][11].Most of these studies have discussed pseudocysts or retention cysts depicted adjacent to the PDAC or in the extrapancreatic area in the clinical setting of pancreatitis [8][9][10][11], where...

Pancreas ductal adenocarcinoma with cystic features on cross-sectional imaging: radiologic-pathologic correlation

“…Yoon et al (4) proposed neoplastic mucin cyst as a new classification of intratumoral cystic lesion of PDA. Both neoplastic mucin cysts and large-duct cysts are lined by mucin-producing neoplastic cells.…”

“…Neoplastic mucin cysts in PDAs (Fig. 4) have smooth margin and they are usually solitary, but occasionally a few cysts are seen (4).…”

“…1, 2). The size of cysts is small, usually 0.5-0.7 cm in diameter, occasionally exceeding 1 cm (3,4). Although rare, multiple small intratumoral cysts of large-duct type can show honeycomb-like appearance on cross-sectional images ( Fig.…”

64-Slice spiral computed tomography and three-dimensional reconstruction in the diagnosis of cystic pancreatic tumors

“…Overall, 3D reconstruction techniques may provide an important source of information for the surgical team as they can aid the visualization of: Tumor location, size and shape; the pancreatic wall; cavity wall nodules; calcifications; the main pancreatic duct; the connections between the tumor and the pancreatic duct; and the associations between the tumor and the adjacent organs and blood vessels (11). On the basis of these advantages, multi-slice CT may become the standard diagnostic method for cystic pancreatic tumors (12).…”

Differentiating Pancreatic Ductal Adenocarcinoma from Pancreatic Serous Cystadenoma, Mucinous Cystadenoma, and a Pseudocyst with Detailed Analysis of Cystic Features on CT Scans: a Preliminary Study

“…Although the tumors are predominantly solid, cystlike features (cystic degeneration, retention cysts, and attached pseudocysts) were found at histologic analysis in 8% of ductal adenocarcinomas ( 3 - 6 ). Moreover, pancreatic ductal adenocarcinomas with cystic features (PDAC) are sometimes radiographically similar to some other cystic pancreatic lesions ( 2 , 7 , 8 ), including pancreatic serous cystadenoma (SCN), mucinous cystadenoma (MCN), pseudocyst, and so on. Serous cystadenoma are benign tumors, and in asymptomatic patients, do not require surgical excision.…”