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Cystic Lesions of the Pancreas

¹ Department of Radiology, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL 60153.
² Department of Surgery, Surgical Oncology Section, Loyola University Medical Center, Maywood, IL 60153.

View larger version (134K): [in a new window]   Fig. 1. —Autosomal dominant polycystic kidney disease in 41-year-old man. CT scan shows small cyst (arrow) in body of pancreas. Note enlarged polycystic kidneys and small hepatic cysts.

View larger version (123K): [in a new window]   Fig. 2. —Von Hippel-Lindau disease in 37-year-old man. CT scan shows small pancreatic cysts (arrows), multiple renal cysts, and renal cell carcinoma.

View larger version (120K): [in a new window]   Fig. 3. —Cystic fibrosis with cystosis in 33-year-old man. CT scan shows 1- to 1.5-cm cysts (arrows) in fatty replaced pancreas. Gallbladder is filled with tiny calcified stones.

View larger version (131K): [in a new window]   Fig. 4. —Lymphoepithelial cyst in asymptomatic 54-year-old woman. CT scan shows nonspecific 2-cm cyst (arrow) in tail of pancreas. Diagnosis was made after tail was resected.

View larger version (96K): [in a new window]   Fig. 5. —Pseudocyst in 10-year-old girl. CT scan shows posttraumatic thin-walled pseudocyst of pancreas.

View larger version (137K): [in a new window]   Fig. 6. —Calcified pseudocyst in 44-year-old man with chronic pancreatitis. CT scan shows pseudocyst with calcified wall in head of pancreas.

View larger version (143K): [in a new window]   Fig. 7. —Pancreatic abscess containing gas in 54-year-old man. CT scan shows large fluid collection containing gas bubbles in pancreatic bed due to abscess complicating acute pancreatitis. Note infiltration of peripancreatic fat and calcified gallstones.

View larger version (156K): [in a new window]   Fig. 8A. —Pancreatic gas caused by pancreatic—enteric fistula in asymptomatic 58-year-old man. CT scan shows small thin-walled collection with air—fluid level (arrow) in tail of pancreas on follow-up several weeks after episode of acute pancreatitis.

View larger version (167K): [in a new window]   Fig. 8B. —Pancreatic gas caused by pancreatic—enteric fistula in asymptomatic 58-year-old man. Image from barium enema confirms fistula (arrows) between colon and pancreas as source of gas.

View larger version (147K): [in a new window]   Fig. 9. —Mucinous adenocarcinoma in 66-year-old woman. CT scan shows well-defined cystic component of mass in tail of pancreas. Note liver metastasis (arrow).

View larger version (134K): [in a new window]   Fig. 10. —Microcystic adenoma in 76-year-old woman. CT scan shows large low-attenuation, well-demarcated mass in head of pancreas. Note characteristic stellate scar.

View larger version (117K): [in a new window]   Fig. 11A. —Microcystic adenoma in 85-year-old woman. Unenhanced CT scan shows large hypodense mass with punctate central calcification in body of pancreas.

View larger version (154K): [in a new window]   Fig. 11B. —Microcystic adenoma in 85-year-old woman. CT scan after IV administration of contrast material shows enhancing walls of cysts.

View larger version (127K): [in a new window]   Fig. 12A. —Microcystic adenoma and adenocarcinoma in 97-year-old woman with multiple liver metastases. CT scans show microcystic adenoma in pancreatic head that consists of small cysts (A) and synchronous solid adenocarcinoma (arrow, B) in tail of pancreas (B).

View larger version (116K): [in a new window]   Fig. 12B. —Microcystic adenoma and adenocarcinoma in 97-year-old woman with multiple liver metastases. CT scans show microcystic adenoma in pancreatic head that consists of small cysts (A) and synchronous solid adenocarcinoma (arrow, B) in tail of pancreas (B).

View larger version (139K): [in a new window]   Fig. 13. —Mucinous cystic tumor in 52-year-old woman. CT scan shows unilocular cystic pancreatic mass that had slightly decreased in size over 3-month interval, but patient had no history of pancreatitis, gallstones, or abdominal trauma. Pancreatic tail was resected, and mucinous cystic tumor was diagnosed.

View larger version (137K): [in a new window]   Fig. 14. —Mucinous cystic tumor in 44-year-old woman. CT scan shows cystic mass containing faint septa and punctate peripheral calcifications.

View larger version (172K): [in a new window]   Fig. 15. —Mucinous cystic tumor (cystadenocarcinoma) in 41-year-old woman. CT scan shows irregularly thickened wall of cystic mass that contains soft-tissue nodules.

View larger version (140K): [in a new window]   Fig. 16. —Mucinous cystic tumor (cystadenocarcinoma) in 72-year-old woman. CT scan shows large cystic mass. Note irregularly thickened wall, nodular excrescences, and smaller peripheral cysts (arrows).

View larger version (117K): [in a new window]   Fig. 17A. —Intraductal papillary mucinous tumor in 69-year-old woman. Neoplasm involves both main and pancreatic head side ducts. ERCP image shows dilated main pancreatic duct and marked dilatation of side branches in pancreatic head. The patient's clinical diagnosis was chronic pancreatitis.

View larger version (123K): [in a new window]   Fig. 17B. —Intraductal papillary mucinous tumor in 69-year-old woman. Neoplasm involves both main and pancreatic head side ducts. CT scan shows atrophic pancreatic tail and dilatation of main pancreatic duct.

View larger version (126K): [in a new window]   Fig. 17C. —Intraductal papillary mucinous tumor in 69-year-old woman. Neoplasm involves both main and pancreatic head side ducts. CT scan shows cystlike dilated branches of side ducts (arrows) in pancreatic head.

View larger version (159K): [in a new window]   Fig. 18A. —Intraductal papillary mucinous tumor in 57-year-old man. Neoplasm is isolated to main pancreatic duct. CT scan shows dilated main duct (arrows) in pancreatic body and tail.

View larger version (192K): [in a new window]   Fig. 18B. —Intraductal papillary mucinous tumor in 57-year-old man. Neoplasm is isolated to main pancreatic duct. Dilated main pancreatic duct is shown on ERCP image. Side ducts are normal.

View larger version (115K): [in a new window]   Fig. 19. —Cystic insulinomas in 36-year-old woman with multiple endocrine neoplasia type 1. CT scan shows small cystic masses (arrows) in body and tail of pancreas. Patient presented with primary hyperparathyroidism.

View larger version (126K): [in a new window]   Fig. 20. —Cystic glucagonoma in 34-year-old woman. CT scan shows large cystic mass in tail of pancreas. Patient had diabetes and presented with characteristic eczematous dermatitis termed "necrolytic migratory erythema."

View larger version (150K): [in a new window]   Fig. 21. —Cystic nonfunctioning neuroendocrine neoplasm in 65-year-old man. CT scan shows cystic elements in neoplasm extending from tail of pancreas.

View larger version (102K): [in a new window]   Fig. 22. —Solid papillary epithelial neoplasm in 13-year-old girl. CT scan 1 day after blunt abdominal trauma shows sharply defined water-density mass deforming pancreatic head. Before trauma and this serendipitous discovery, patient was asymptomatic.

View larger version (141K): [in a new window]   Fig. 23A. —Giant cell tumor, osteoclastic type, in 66-year-old woman. Unenhanced T1-weighted spin-echo MR image shows lobulated, low-signal-intensity mass (arrows) protruding from tail of pancreas.

View larger version (140K): [in a new window]   Fig. 23B. —Giant cell tumor, osteoclastic type, in 66-year-old woman. Unenhanced T2-weighted inversion-recovery MR image shows high-signal-intensity cystic component of lesion.

View larger version (117K): [in a new window]   Fig. 24. —Leiomyosarcoma in 44-year-old woman. CT scan shows cystic mass with well-defined wall in body of pancreas. Note dilatation of pancreatic duct (arrow).

View larger version (126K): [in a new window]   Fig. 25. —Metastatic colon carcinoma in 55-year-old man. CT scan shows multiple cystic pancreatic (arrows) and parapancreatic metastases. Retrocaval lymph node metastasis has same cystic appearance. Note liver metastasis.

View larger version (116K): [in a new window]   Fig. 26. —Metastatic melanoma in 61-year-old man. CT scan shows lobulated cystic mass in body of pancreas.

View larger version (118K): [in a new window]   Fig. 27. —Multiple myeloma in 72-year-old woman. CT scan shows irregular cystic mass in pancreatic body and dilated duct in pancreatic tail. Note also soft-tissue mass in pancreatic head.

View larger version (118K): [in a new window]   Fig. 28. —Metastatic renal cell carcinoma in 70-year-old woman. CT scan shows large cystic mass with irregularly thickened wall in pancreatic body and tail. Note similarity to renal cell carcinoma of right kidney. Pancreatic mass proved to be metastatic lesion.

View larger version (158K): [in a new window]   Fig. 29. —Parapancreatic lymphangioma in 59-year-old man. CT scan shows large water-attenuation mass with imperceptible wall contiguous with body and tail of pancreas.

View larger version (113K): [in a new window]   Fig. 30A. —Parapancreatic paraganglioma in 64-year-old man. CT scan shows parapancreatic mass with cystic component that deforms pancreatic head and simulates intrinsic pancreatic lesion.

View larger version (133K): [in a new window]   Fig. 30B. —Parapancreatic paraganglioma in 64-year-old man. CT image 2 cm inferior to A shows same findings.

View larger version (155K): [in a new window]   Fig. 31. —Parapancreatic metastasis from testicular carcinoma in 21-year-old man. CT scan shows large low-attentuation lymph node metastasis displacing pancreatic head anteriorly and inferior vena cava laterally.

View larger version (118K): [in a new window]   Fig. 32. —Parapancreatic retroperitoneal cystic teratoma in 8-year-old girl. CT scan shows heterogeneous lesion displacing pancreas and kidney and containing large central calcification, peripheral water-attenuation cystic areas, and small focus of fat (arrow).

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