Top

Published in:

01-04-2015 | Gastrointestinal

Mucinous cystic neoplasms and serous cystadenomas arising in the body-tail of the pancreas: MR imaging characterization

Authors: Riccardo Manfredi, Anna Ventriglia, William Mantovani, Sara Mehrabi, Enrico Boninsegna, Giuseppe Zamboni, Roberto Salvia, Roberto Pozzi Mucelli

Published in: European Radiology | Issue 4/2015

Abstract

Purpose

To identify magnetic resonance (MR)/MR cholangiopancreatography (MRCP) imaging signs helpful in the differential diagnosis between serous cystadenomas (SCAs) and mucinous cystic neoplasms (MCNs), arising from the body/tail of the pancreas.

Material and methods

This retrospective study had institutional review board approval and informed consent was waived. Fifty-three patients with non-communicating cystic pancreatic neoplasm of the body/tail, undergoing MR/MRCP, were included. Qualitative image analysis assessed the macroscopic pattern, number of cysts, presence of central scar, contrast enhancement of peripheral wall, and mural nodules. Quantitative analysis assessed the maximum diameter of the neoplasm, thickness of the peripheral wall, and calibre of the upstream main pancreatic duct.

Results

Histopathology results revealed that 27/53 (51 %) were SCAs, 26/53 (49 %) were MCNs. Microcystic pattern was observed in 88.2 % of SCAs and 11.8 % of MCNs; macrocystic pattern was observed in 90.5 % of MCNs and 9.5 % of SCAs (p < 0.0001). Central scar was detected in 29.6 % of SCAs and no MCNs (p = 0.003). Contrast enhancement of the peripheral wall was evident in 99.5 % of MCNs and 11.5 % of SCAs (p < 0.0001); mural nodules were depicted in 94.1 % of MCNs and 5.9 % of SCAs (p < 0.0001).

Median maximum diameter was 54 mm for MCNs, 32 mm for SCAs (p = 0.001); median wall thickness was 4 mm for MCNs, 2 mm for SCAs (p < 0.0001).

Conclusions

Macrocystic pattern, enhancement of a peripheral wall and mural nodules are suggestive of MCNs; whereas microcystic pattern, lack of peripheral wall and central scar are suggestive of SCAs.

Key Points

• MCNs have macrocystic patterns, contrast enhancement of the peripheral wall and mural nodules

• Microcystic pattern and central scar are suggestive of SCA

• Mural nodules detected in MCNs correlate with epithelial dysplasia

• Chronic obstructive pancreatitis is equally depicted in patients with MCNs and SCAs

Basturk O, Coban I, Adsay NV (2009) Pancreatic cysts: pathologic classification, differential diagnosis, and clinical implications. Arch Pathol Lab Med 133:423–438PubMed

Compagno J, Oertel JE (1978) Mucinous cystic neoplasms of the pancreas with overt and latent malignancy (cystadenocarcinoma and cystadenoma). A clinicopathologic study of 41 cases. Am J Clin Pathol 69:573–580PubMed

Tanaka M, Chari S, Adsay V et al (2006) International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 6:17–32CrossRefPubMed

Zamboni G, Fukushima N, Hruban R, Klöppel G (2010) Mucinous cystic neoplasms of the pancreas. In: Bosman FT, Carneiro F, Hruban RH, Theise ND (eds) WHO classification of tumours of the digestive system. IARC, Lyon, pp 300–303

Zamboni G, Scarpa A, Bogina G et al (1999) Mucinous cystic tumors of the pancreas: clinicopathological features, prognosis, and relationship to other mucinous cystic tumors. Am J Surg Pathol 23:410–422CrossRefPubMed

Thompson LD, Becker RC, Przygodzki RM, Adair CF, Heffess CS (1999) Mucinous cystic neoplasm (mucinous cystadenocarcinoma of low-grade malignant potential) of the pancreas: a clinicopathologic study of 130 cases. Am J Surg Pathol 23:1–16CrossRefPubMed

Crippa S, Salvia R, Warshaw AL et al (2008) Mucinous cystic neoplasm of the pancreas is not an aggressive entity: lessons from 163 resected patients. Ann Surg 247:571–579CrossRefPubMedCentralPubMed

Fritz S, Warshaw AL, Thayer SP (2009) Management of mucin-producing cystic neoplasms of the pancreas. Oncologist 14:125–136CrossRefPubMedCentralPubMed

Gaujoux S, Brennan MF, Gonen M et al (2011) Cystic lesions of the pancreas: changes in the presentation and management of 1,424 patients at a single institution over a 15-year time period. J Am Coll Surg 212:590–600, discussion 600–593CrossRefPubMed

10.

Bassi C, Salvia R, Molinari E, Biasutti C, Falconi M, Pederzoli P (2003) Management of 100 consecutive cases of pancreatic serous cystadenoma: wait for symptoms and see at imaging or vice versa? World J Surg 27:319–323CrossRefPubMed

11.

Manfredi R, Bonatti M, D'Onofrio M et al (2012) Incidentally discovered benign pancreatic cystic neoplasms not communicating with the ductal system: MR/MRCP imaging appearance and evolution. Radiol Med. doi:10.1007/s11547-012-0837-3

12.

Crippa S, Fernandez-Del Castillo C, Salvia R et al (2010) Mucin-producing neoplasms of the pancreas: an analysis of distinguishing clinical and epidemiologic characteristics. Clin Gastroenterol Hepatol 8:213–219CrossRefPubMedCentralPubMed

13.

Manfredi R, Graziani R, Motton M et al (2009) Main pancreatic duct intraductal papillary mucinous neoplasms: accuracy of MR imaging in differentiation between benign and malignant tumors compared with histopathologic analysis. Radiology 253:106–115CrossRefPubMed

14.

Sahani DV, Kadavigere R, Saokar A, Fernandez-del Castillo C, Brugge WR, Hahn PF (2005) Cystic pancreatic lesions: a simple imaging-based classification system for guiding management. Radiographics 25:1471–1484CrossRefPubMed

15.

Salvia R, Partelli S, Crippa S et al (2009) Intraductal papillary mucinous neoplasms of the pancreas with multifocal involvement of branch ducts. Am J Surg 198:709–714CrossRefPubMed

16.

Berland LL, Silverman SG, Gore RM et al (2010) Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol 7:754–773CrossRefPubMed

17.

Lee KS, Sekhar A, Rofsky NM, Pedrosa I (2010) Prevalence of incidental pancreatic cysts in the adult population on MR imaging. Am J Gastroenterol 105:2079–2084CrossRefPubMed

18.

Kalb B, Sarmiento JM, Kooby DA, Adsay NV, Martin DR (2009) MR imaging of cystic lesions of the pancreas. Radiographics 29:1749–1765CrossRefPubMed

19.

Reddy RP, Smyrk TC, Zapiach M et al (2004) Pancreatic mucinous cystic neoplasm defined by ovarian stroma: demographics, clinical features, and prevalence of cancer. Clin Gastroenterol Hepatol 2:1026–1031CrossRefPubMed

20.

Andrejevic-Blant S, Kosmahl M, Sipos B, Kloppel G (2007) Pancreatic intraductal papillary-mucinous neoplasms: a new and evolving entity. Virchows Arch 451:863–869CrossRefPubMedCentralPubMed

21.

Kosmahl M, Pauser U, Peters K et al (2004) Cystic neoplasms of the pancreas and tumor-like lesions with cystic features: a review of 418 cases and a classification proposal. Virchows Arch 445:168–178CrossRefPubMed

22.

Griffin N, Charles-Edwards G, Grant LA (2012) Magnetic resonance cholangiopancreatography: the ABC of MRCP. Insights Imaging 3:11–21CrossRefPubMedCentralPubMed

23.

Delavaud C, d’Assignies G, Cros J et al (2014) CT and MR imaging of multilocular acinar cell cystadenoma: comparison with branch duct intraductal papillary mucinous neoplasia (IPMNs). Eur Radiol. doi:10.1007/s00330-014-3248-0 PubMed

24.

Manfredi R, Bonatti M, Mantovani W et al (2013) Non-hyperfunctioning neuroendocrine tumours of the pancreas: MR imaging appearance and correlation with their biological behaviour. Eur Radiol 23:3029–3039CrossRefPubMed

25.

Wu J, Jiao Y, Dal Molin M et al (2011) Whole-exome sequencing of neoplastic cysts of the pancreas reveals recurrent mutations in components of ubiquitin-dependent pathways. Proc Natl Acad Sci U S A 108:21188–21193CrossRefPubMedCentralPubMed

Title: Mucinous cystic neoplasms and serous cystadenomas arising in the body-tail of the pancreas: MR imaging characterization
Authors: Riccardo Manfredi
Anna Ventriglia
William Mantovani
Sara Mehrabi
Enrico Boninsegna
Giuseppe Zamboni
Roberto Salvia
Roberto Pozzi Mucelli
Publication date: 01-04-2015
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 4/2015
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-014-3493-2

At a glance: The STEP trials

Springer Medicine

Mucinous cystic neoplasms and serous cystadenomas arising in the body-tail of the pancreas: MR imaging characterization

Abstract

Purpose

Material and methods

Results

Conclusions

Key Points

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Material and methods

Results

Conclusions

Key Points

Please log in to get access to this content

Other articles of this Issue 4/2015

Local tumour progression after ultrasound-guided microwave ablation of liver malignancies: risk factors analysis of 2529 tumours

Contrast agent and radiation dose reduction in abdominal CT by a combination of low tube voltage and advanced image reconstruction algorithms

Abdominal CT during pregnancy: a phantom study on the effect of patient centring on conceptus radiation dose and image quality

Fused aortic valve without an elliptical-shaped systolic orifice in patients with severe aortic stenosis: cardiac computed tomography is useful for differentiation between bicuspid aortic valve with raphe and tricuspid aortic valve with commissural fusion

Disadvantages of using the area under the receiver operating characteristic curve to assess imaging tests: A discussion and proposal for an alternative approach

Tumour 18 F-FDG Uptake on preoperative PET/CT may predict axillary lymph node metastasis in ER-positive/HER2-negative and HER2-positive breast cancer subtypes