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Pancreatic Tumors: Emphasis on CT Findings and Pathologic Classification

Cho HW, Choi JY, Kim MJ, Park MS, Lim JS, Chung YE, Kim KW - Korean J Radiol (2011)

Bottom Line: The subtypes include solid tumors, mixed cystic and solid lesions, unilocular cysts, multilocular cystic lesions, and microcystic lesions.Each subtype has different kinds of tumors and malignant potential, thus the classification can be useful for a better differential diagnosis and treatment planning.For this purpose, we suggest an appropriate modified classification system by using the imaging features of pancreatic tumors with an emphasis on CT findings and illustrate various findings of typical and atypical manifestations.

Affiliation: Department of Radiology and the Research Institute of Radiological Sciences, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea.

ABSTRACT

Pancreatic tumors can be classified by their morphologic features on CT. The subtypes include solid tumors, mixed cystic and solid lesions, unilocular cysts, multilocular cystic lesions, and microcystic lesions. Endoscopic US and MRI can provide detailed information for classifying pancreatic lesions. Each subtype has different kinds of tumors and malignant potential, thus the classification can be useful for a better differential diagnosis and treatment planning. For this purpose, we suggest an appropriate modified classification system by using the imaging features of pancreatic tumors with an emphasis on CT findings and illustrate various findings of typical and atypical manifestations.

66-year-old man with microcystic serous cystadenoma manifesting as microcystic lesion.A. Contrast-enhanced transverse CT during arterial phase shows hypervascular mass (white arrow) in tail of pancreas. It appears as solid lesion on CT, owing to innumerable cysts and fine septa. B. Note cystic portion in periphery of tumor (white arrow). C. Axial T2-weighted image reveals microcystic mass. D. Gross specimen shows multilocular, well-defined bulging mass containing multiple tiny cystic spaces and sanguineous clear fluid (white arrow), which are confirmed as microcystic serous cystadenoma.
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Figure 10: 66-year-old man with microcystic serous cystadenoma manifesting as microcystic lesion.A. Contrast-enhanced transverse CT during arterial phase shows hypervascular mass (white arrow) in tail of pancreas. It appears as solid lesion on CT, owing to innumerable cysts and fine septa. B. Note cystic portion in periphery of tumor (white arrow). C. Axial T2-weighted image reveals microcystic mass. D. Gross specimen shows multilocular, well-defined bulging mass containing multiple tiny cystic spaces and sanguineous clear fluid (white arrow), which are confirmed as microcystic serous cystadenoma.

Mentions: Serous microcystic cystadenoma is the only cystic lesion included in this category. The typical CT appearance of this tumor is similar to that of a sponge or honeycomb with innumerable tiny cystic spaces septated by thin septa. The septa may coalesce into a characteristic central stellate scar that may calcify itself, which is considered to be pathognomonic for serous cystadenoma and found in about 20% of tumors. The small size of the cysts and the innumerable enhancing septa may cause the mass to appear solid on CT. Microcysts may be seen as numerous discrete foci with bright signal intensity on T2-weighted MR images (Fig. 10), and have little free fluid in the locules on EUS (5, 10, 12, 13).

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Pancreatic Tumors: Emphasis on CT Findings and Pathologic Classification

Cho HW, Choi JY, Kim MJ, Park MS, Lim JS, Chung YE, Kim KW - Korean J Radiol (2011)

66-year-old man with microcystic serous cystadenoma manifesting as microcystic lesion.A. Contrast-enhanced transverse CT during arterial phase shows hypervascular mass (white arrow) in tail of pancreas. It appears as solid lesion on CT, owing to innumerable cysts and fine septa. B. Note cystic portion in periphery of tumor (white arrow). C. Axial T2-weighted image reveals microcystic mass. D. Gross specimen shows multilocular, well-defined bulging mass containing multiple tiny cystic spaces and sanguineous clear fluid (white arrow), which are confirmed as microcystic serous cystadenoma.
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Figure 10: 66-year-old man with microcystic serous cystadenoma manifesting as microcystic lesion.A. Contrast-enhanced transverse CT during arterial phase shows hypervascular mass (white arrow) in tail of pancreas. It appears as solid lesion on CT, owing to innumerable cysts and fine septa. B. Note cystic portion in periphery of tumor (white arrow). C. Axial T2-weighted image reveals microcystic mass. D. Gross specimen shows multilocular, well-defined bulging mass containing multiple tiny cystic spaces and sanguineous clear fluid (white arrow), which are confirmed as microcystic serous cystadenoma.
Mentions: Serous microcystic cystadenoma is the only cystic lesion included in this category. The typical CT appearance of this tumor is similar to that of a sponge or honeycomb with innumerable tiny cystic spaces septated by thin septa. The septa may coalesce into a characteristic central stellate scar that may calcify itself, which is considered to be pathognomonic for serous cystadenoma and found in about 20% of tumors. The small size of the cysts and the innumerable enhancing septa may cause the mass to appear solid on CT. Microcysts may be seen as numerous discrete foci with bright signal intensity on T2-weighted MR images (Fig. 10), and have little free fluid in the locules on EUS (5, 10, 12, 13).

Bottom Line: The subtypes include solid tumors, mixed cystic and solid lesions, unilocular cysts, multilocular cystic lesions, and microcystic lesions.Each subtype has different kinds of tumors and malignant potential, thus the classification can be useful for a better differential diagnosis and treatment planning.For this purpose, we suggest an appropriate modified classification system by using the imaging features of pancreatic tumors with an emphasis on CT findings and illustrate various findings of typical and atypical manifestations.

Affiliation: Department of Radiology and the Research Institute of Radiological Sciences, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea.

ABSTRACT

Pancreatic tumors can be classified by their morphologic features on CT. The subtypes include solid tumors, mixed cystic and solid lesions, unilocular cysts, multilocular cystic lesions, and microcystic lesions. Endoscopic US and MRI can provide detailed information for classifying pancreatic lesions. Each subtype has different kinds of tumors and malignant potential, thus the classification can be useful for a better differential diagnosis and treatment planning. For this purpose, we suggest an appropriate modified classification system by using the imaging features of pancreatic tumors with an emphasis on CT findings and illustrate various findings of typical and atypical manifestations.

View Similar Images In: Results  - Collection
View Article: PubMed Central -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=3194778&rFormat=json&query=null&req=5