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General Surgery
Cystic Neoplasms of the Pancreas
Built from Maingot's Abdominal Operations
What’s inside
7 sections · 142 slides
Overview
- Scope of this topic
Cystic lesions of the pancreas
What they are, how often they appear, and why the label matters
- Cystic lesions of the pancreas
- Frequency and detection of pancreatic cysts
- Prognostic importance of the diagnosis
- Aims of the diagnostic approach
- Information used to reach a diagnosis
- Diagnostic pathway for a pancreatic cyst
- Size thresholds from decision modelling
- Non-neoplastic cysts of the pancreas
- The three commonest cystic neoplasms
- Classification of pancreatic cystic lesions
- Separating the two mucus-producing tumours
- Solid pseudopapillary neoplasm in outline
- WHO classification of pancreatic cystic neoplasms
- Structure of the WHO classification
Serous cystic neoplasms
The watery, almost always benign tumour
- Serous cystic neoplasm: definition and older names
- Gross features of serous cystic neoplasms
- Oligocystic variant of serous cystic neoplasm
- CT of a serous cystic neoplasm in the head and neck of the pancreas
- Microscopic features of serous cystic neoplasms
- Microscopic appearance of a serous cystic neoplasm
- Cyst fluid findings in serous cystic neoplasms
- Malignant potential of serous cystic neoplasms
- Johns Hopkins experience with resected serous cystic neoplasms
- Criteria that do not establish malignancy
- Age and sex distribution of serous cystic neoplasms
- Presenting symptoms of serous cystic neoplasms
- Distribution within the gland
- Von Hippel-Lindau syndrome and serous cystic neoplasms
- Imaging appearance of serous cystic neoplasms
- Accuracy of CT in serous cystic neoplasms
- CT features predictive of serous cystic neoplasm
- CT compared with MRI in serous cystic neoplasms
- CT of a cystic lesion in the head of the pancreas abutting the duodenum
- Complications of EUS-guided fine-needle aspiration
- Limits of cyst fluid cytology
- Endoscopic ultrasound surveillance of incidental cysts
- Cyst fluid chemistry in the differential diagnosis
- Cyst fluid protein expression profiling
- Observation of serous cystic neoplasms
- Growth rate and size threshold for resection
- Operations used for serous cystic neoplasms
- Parenchyma-sparing options and their risks
- Follow-up after diagnosis of serous cystic neoplasm
- CT of a large cystic mass with solid components in the pancreatic head
Mucinous cystic neoplasms
The mucus-producing tumour of women, with true malignant potential
- Mucinous cystic neoplasm: importance of the distinction
- Frequency among pancreatic cystic neoplasms
- Gross and microscopic features of mucinous cystic neoplasms
- Ovarian-type stroma as a diagnostic requirement
- Columnar epithelium over ovarian-type stroma in a mucinous cystic neoplasm
- Proposed origin of mucinous cystic neoplasms
- Adenoma to carcinoma sequence in mucinous cystic neoplasms
- Grading a mucinous cystic neoplasm
- Types of invasive cancer arising in mucinous cystic neoplasms
- Sex and age at presentation of mucinous cystic neoplasms
- Effect of applying the ovarian-stroma criterion
- Symptoms of mucinous cystic neoplasms
- Imaging features of mucinous cystic neoplasms
- Distinguishing a mucinous cystic neoplasm from a pseudocyst
- CT of a large homogeneous pancreatic mass mistaken for a pseudocyst
- Cyst fluid carcinoembryonic antigen in mucinous lesions
- DNA analysis of cyst fluid
- Size and nodules as predictors of cancer in mucinous cystic neoplasms
- Selecting mucinous cystic neoplasms for observation
- Why biopsy cannot exclude cancer in a mucinous cystic neoplasm
- Indications for resection of mucinous cystic neoplasms
- Extent of resection and lymphadenectomy
- Survival after resection of mucinous cystic neoplasms
- Survival curves for invasive and noninvasive mucinous cystic neoplasms
- Adjuvant therapy and follow-up in mucinous cystic neoplasms
- Surveillance after resection of mucinous cystic neoplasms
Intraductal papillary mucinous neoplasms
Mucus-filled duct disease that spans adenoma to invasive cancer
- Intraductal papillary mucinous neoplasm: earlier names and first report
- WHO recognition and defining features of IPMN
- CT of a multiloculated cystic mass with pancreatic duct dilatation
- Histological features of IPMN
- Duct involvement patterns in IPMN
- Significance of the duct pattern
- Distal pancreatectomy specimen showing a mass in a dilated main pancreatic duct
- Gastric-foveolar pattern of IPMN
- Villous-intestinal pattern of IPMN
- Microscopic appearance of a colloid carcinoma within an IPMN
- Pancreatobiliary pattern of IPMN
- Grades of dysplasia in IPMN
- Microscopic appearance of an IPMN with borderline features
- IPMN compared with pancreatic intraepithelial neoplasia
- Molecular features separating IPMN from ductal adenocarcinoma
- Symptoms by duct type in IPMN
- Age, sex and risk of malignancy in IPMN
- Separate ductal adenocarcinoma in the same gland
- Predictors of concomitant ductal carcinoma
- Cyst growth during observation
- Extrapancreatic neoplasms in IPMN patients
- Imaging of IPMN
- Imaging features suggesting malignancy in IPMN
- Multifocal branch duct IPMN under observation
- Endoscopic ultrasound and mural nodules
- Cyst fluid markers in IPMN
- Japanese multi-institutional study of IPMN
- Findings that separated malignant from benign IPMN
- Sendai consensus guidelines: indications for resection
- Sendai pathway for branch duct IPMN
- Triggers for resection during follow-up
- Testing the consensus guidelines
- Mural nodules versus size as predictors
- Natural history of branch duct IPMN without nodules
- Cyst size in flat branch duct IPMN
- Practical surveillance of small branch duct IPMN
- Survival after resection of invasive IPMN
- Adjuvant chemoradiotherapy for invasive IPMN
- Survival curves for noninvasive and invasive IPMN after resection
- Operations for IPMN
- Frozen section of the pancreatic margin
- Total pancreatectomy and remnant surveillance
Unusual cystic neoplasms
Solid pseudopapillary, neuroendocrine, acinar and cancers that look cystic
- Solid pseudopapillary neoplasm: clinical features
- Pathology and outcome of solid pseudopapillary neoplasm
- CT of a solid and papillary neoplasm within the duodenal C loop
- CT of the same tumour deforming the superior mesenteric vein
- Cystic neuroendocrine neoplasms
- Cystic compared with solid neuroendocrine tumours
- Cystic acinar cell neoplasms
- Cystic degeneration of pancreatic ductal adenocarcinoma
Bringing the three lesions together
Side-by-side features, treatment thresholds and take-home points
- Classic features of the three main cystic neoplasms
- Treatment thresholds for the three main cystic neoplasms
- Features and treatment of serous, mucinous and intraductal papillary mucinous neoplasms
- Cyst fluid patterns across the three lesions
- Take-home points on diagnosis
- Take-home points on management
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- Maingot's Abdominal Operations, 12th Edition