Pancreatic Cystic Lesions: Diagnostic Management and Indications for Operation. Part II
Ferdinand BauerReview Articles, no. 3, 2018
Article DOI: 10.21614/chirurgia.113.3.318
Mucinous Cystic Neoplasms (MCN) occur almost exclusively in women during premenopause (> 90%) (1) and represent approximately 10% of the cystic lesions of the pancreas and 8% of the resected lesions (2).
Therefore, a MCN will always be suspected when a medial-distal (corporeo-caudal) cystic lesion is identified in a middle-aged woman, the "mother" tumour, with no history of pancreatitis. Unlike SCN (serous cystic neoplasm), MCN are often malignant or they have a malignant potential (3). They are usually corporeo-caudal (> 95%), very rarely cephalic (2). They are generally solitary lesions (4) with sizes between 3.5 and 6 cm (much smaller than those reported in the literature if we consider incidental findings) or with few macrocysts delimited by thin fibrous walls (Fig. 11, 12) (5).
Cyst wall, septa and mural nodules are more pronounced after contrast administration (Fig. 12 C) (6, 7, 8). The MCN content is generally mucinous (with fluid densities at CT, hyperintense at T2 and hypointense at T1) (9, 7), but it can also be aqueous, necrotic or hemorrhagic (2). The presence of solid components and dysplasia is often associated with invasive behaviour (10).
Peripheral calcifications are rare (<20%), particularly visible in CT, and may indicate a malignant lesion (6). The complex internal cyst architecture can be better observed by MRI (Fig. 12 A, C) or echoendoscopy, which helps differentiate from the serous cystadenoma.
Therefore, a MCN will always be suspected when a medial-distal (corporeo-caudal) cystic lesion is identified in a middle-aged woman, the "mother" tumour, with no history of pancreatitis. Unlike SCN (serous cystic neoplasm), MCN are often malignant or they have a malignant potential (3). They are usually corporeo-caudal (> 95%), very rarely cephalic (2). They are generally solitary lesions (4) with sizes between 3.5 and 6 cm (much smaller than those reported in the literature if we consider incidental findings) or with few macrocysts delimited by thin fibrous walls (Fig. 11, 12) (5).
Cyst wall, septa and mural nodules are more pronounced after contrast administration (Fig. 12 C) (6, 7, 8). The MCN content is generally mucinous (with fluid densities at CT, hyperintense at T2 and hypointense at T1) (9, 7), but it can also be aqueous, necrotic or hemorrhagic (2). The presence of solid components and dysplasia is often associated with invasive behaviour (10).
Peripheral calcifications are rare (<20%), particularly visible in CT, and may indicate a malignant lesion (6). The complex internal cyst architecture can be better observed by MRI (Fig. 12 A, C) or echoendoscopy, which helps differentiate from the serous cystadenoma.
