Intraductal Papillary Mucinous Tumors of the Pancreas

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Intraductal Papillary Mucinous Tumors of the Pancreas

Anne M. Silas¹, Martina M. Morrin, Vassilios Raptopoulos and Mary T. Keogan

^¹ All authors: Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215.

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Fig. 1. —77-year-old man with epigastric pain. Coronal MR cholangiopancreatogram (TR/TE, 2800/1100) shows cystic dilatation of side-branch duct within uncinate process. Note large filling defect that represents mucin plug (arrow).

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Fig. 2A. —70-year-old man with chronic abdominal pain. Axial contrast-enhanced CT scans show dilated main pancreatic duct (MPD) and cystic dilatation of side-branch ducts (SB) in pancreatic head.

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Fig. 2B. —70-year-old man with chronic abdominal pain. Axial contrast-enhanced CT scans show dilated main pancreatic duct (MPD) and cystic dilatation of side-branch ducts (SB) in pancreatic head.

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Fig. 2C. —70-year-old man with chronic abdominal pain. Coronal oblique CT reconstruction reveals dilated side-branch duct (arrowhead) and main pancreatic duct (arrow).

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Fig. 2D. —70-year-old man with chronic abdominal pain. Endoscopic retrograde cholangiopancreatogram reveals diffuse involvement both main and side-branch ducts.

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Fig. 3. —53-year-old woman with weight loss. Endoscopic retrograde cholangiopancreatogram shows normal-caliber main pancreatic duct with innumerable dilated side-branch ducts (arrows).

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Fig. 4A. —77-year-old man with jaundice. Axial contrast-enhanced CT scan shows complete replacement of pancreatic head by cystic lesion (arrow).

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Fig. 4B. —77-year-old man with jaundice. Endoscopic retrograde cholangiopancreatogram corresponding to A reveals narrowed main pancreatic duct with upstream duct dilatation and filling of single cystic lesion. Large cystic lesion visualized on CT scan is not opacified. Note malignant transformation was seen in resected specimen but could not be inferred from pre-operative imaging findings.

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Fig. 5A. —43-year-old man with symptoms of pancreatitis. Axial high-resolution contrast-enhanced CT scan (A) and CT oblique reconstruction (B) show cystic lesion contiguous with prominent main pancreatic duct.

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Fig. 5B. —43-year-old man with symptoms of pancreatitis. Axial high-resolution contrast-enhanced CT scan (A) and CT oblique reconstruction (B) show cystic lesion contiguous with prominent main pancreatic duct.

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Fig. 5C. —43-year-old man with symptoms of pancreatitis. Endoscopic retrograde cholangiopancreatogram reveals intraductal mucinous tumor (arrow).

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Fig. 6. —Axial contrast-enhanced CT scan of 70-year-old man with abdominal pain reveals bulging ampulla (arrow) at duodenal sweep.

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Fig. 7A. —72-year-old man with chronic pancreatitis. Endoscopic retrograde cholangiopancreatogram reveals dilated distal main pancreatic duct with communicating cystic lesion (arrow). Proximal main pancreatic duct is not seen.

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Fig. 7B. —72-year-old man with chronic pancreatitis. T2-weighted axial MR image (TR/TE, 4.4/64) shows cysts in pancreatic head (arrow).

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Fig. 7C. —72-year-old man with chronic pancreatitis. T2-weighted MR image at same level as B reveals extensive side-branch disease in body and tail (arrows).

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Fig. 7D. —72-year-old man with chronic pancreatitis. MR cholangiopancreatogram (2800/1100) shows full extent of diffuse disease involving distal main pancreatic duct (wavy arrows) and side-branch ducts (straight arrows).

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Fig. 8. —Axial T2-weighted MR image (TR/TE, 4.4/64) shows papillary excrescence (arrow) in cystic lesion in pancreatic head of 78-year-old woman with abdominal pain.

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Fig. 9A. —77-year-old woman with weight loss. Axial T1-weighted MR image (TR/TE, 128/4.1) reveals low-signal-intensity side-branch duct cysts (arrows).

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Fig. 9B. —77-year-old woman with weight loss. Axial T2-weighted MR image (4.4/64)at same level as A shows high signal of innumerable dilated side-branch duct cysts (arrows) emanating from normal-caliber proximal main pancreatic duct. No surrounding adenopathy is seen.

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Fig. 10A. —77-year-old woman with weight loss. Sonograms show multiple cystic masses in region of pancreatic head (arrows, A) and tail (arrow, B).

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Fig. 10B. —77-year-old woman with weight loss. Sonograms show multiple cystic masses in region of pancreatic head (arrows, A) and tail (arrow, B).

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Fig. 10C. —77-year-old woman with weight loss. MR cholangiopancreatogram (TR/TE, 2800/1100) shows same findings as A and B.

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Fig. 11A. —62-year-old woman with chronic epigastric pain. Intraoperative sonogram shows hypoechoic region (arrows) in head of pancreas.

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Fig. 11B. —62-year-old woman with chronic epigastric pain. Axial contrast-enhanced CT scan reveals multicystic nature of abnormality in pancreatic head (arrow) better than A.

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