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CT of Primary Cystic Pancreatic Neoplasms

Can CT be Used for Patient Triage and Treatment?

¹ All authors: Department of Radiology, The Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287.

View larger version (136K): [in a new window]   Fig. 1A. —34-year-old woman who presented to emergency department with abdominal pain. Contrast-enhanced CT scans show aggressive, atypical mucinous cystadenoma extending into iliopsoas muscle (arrows). All reviewers identified this tumor as either uncertain or definitely mucinous.

View larger version (133K): [in a new window]   Fig. 1B. —34-year-old woman who presented to emergency department with abdominal pain. Contrast-enhanced CT scans show aggressive, atypical mucinous cystadenoma extending into iliopsoas muscle (arrows). All reviewers identified this tumor as either uncertain or definitely mucinous.

View larger version (119K): [in a new window]   Fig. 2A. —Two typical serous cystadenomas, one correctly and one incorrectly diagnosed by reviewers. 74-year-old woman whose primary complaint was early satiety and abdominal bloating. Contrast-enhanced CT scan shows serous cystadenoma composed of many cysts smaller than 2 cm and central tumoral calcifications correctly diagnosed by all reviewers.

View larger version (135K): [in a new window]   Fig. 2B. —Two typical serous cystadenomas, one correctly and one incorrectly diagnosed by reviewers. 71-year-old woman with incidental finding on CT performed for unrelated symptoms. Contrast-enhanced helical CT scan shows serous cystadenoma of head of pancreas (arrow) measuring 2.5 cm and composed of multiple subcentimeter cysts. Compare this benign lesion with mucinous neoplasm shown in Figure 6 and note similarities. All three reviewers mistook this lesion for mucinous neoplasm.

View larger version (150K): [in a new window]   Fig. 3A. —Classic microcystic adenomas in two patients. Contrast-enhanced helical CT scan in 50-year-old woman shows microcystic adenoma (arrowheads). Note multiple small (<1 cm) cysts with tumoral calcification (arrows) in center of mass.

View larger version (166K): [in a new window]   Fig. 3B. —Classic microcystic adenomas in two patients. 76-year-old woman with serous cystadenoma (arrow) incidentally noted on helical CT scan performed for cholecystitis. Mass is well defined and composed of many small (<5 mm) cysts.

View larger version (150K): [in a new window]   Fig. 4. —Contrast-enhanced CT scan in 86-year-old man reveals classic appearance of mucinous cystad-enocarcinoma. Note multiple large cysts (>2 cm) with peripheral tumoral calcification (short arrow), solid components, and mural nodules (long arrow).

View larger version (157K): [in a new window]   Fig. 5. —Contrast-enhanced CT scan in 38-year-old woman shows atypical serous cystadenoma with single large cyst measuring 9 cm. Note that there are no internal septations or peripheral calcifications to suggest mucinous neoplasm. All three reviewers identified this tumor as mucinous or uncertain.

View larger version (163K): [in a new window]   Fig. 6. —Contrast-enhanced CT scan in 65-year-old woman shows atypical mucinous cystadenoma in head of pancreas. Mass (arrow) measures 1.8 cm and contains some small septations. Note similarities between this mucinous neoplasm and serous cystadenoma in Figure 2B. Two reviewers were uncertain of diagnosis and one reviewer mistakenly identified this neoplasm as serous.

View larger version (141K): [in a new window]   Fig. 7A. —CT scans with IV contrast material in 77-year-old woman. Serous cystadenoma of tail of pancreas shows heavy splenic artery calcifications (arrow).

View larger version (144K): [in a new window]   Fig. 7B. —CT scans with IV contrast material in 77-year-old woman. Splenic artery calcifications may be confused with tumoral calcifications (arrow) at periphery of lesion.

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