Solid tumors of the pancreas can put on a mask through cystic change

Abstract

Background: Solid pancreatic tumors such as pancreatic ductal adenocarcinoma (PDAC), solid pseudopapillary tumor (SPT), and pancreatic endocrine tumor (PET) may occasionally manifest as cystic lesions. In this study, we have put together our accumulated experience with cystic manifestations of various solid tumors of the pancreas.

Methods: From 2000 to 2006, 376 patients with pancreatic solid tumor resections were reviewed. Ten (2.66%) of these tumors appeared on radiological imaging studies as cystic lesions. We performed a retrospective review of medical records and pathologic findings of these 10 cases.

Results: Of the ten cases in which solid tumors of the pancreas manifested as cystic lesions, six were PDAC with cystic degeneration, two were SPT undergone complete cystic change, one was cystic PET, and one was a cystic schwannoma. The mean tumor size of the cystic portion in PDAC was 7.3 cm, and three patients were diagnosed as 'pseudocyst' with or without cancer. Two SPT were found incidentally in young women and were diagnosed as other cystic neoplasms. One cystic endocrine tumor was preoperatively suspected as intraductal papillary mucinous neoplasm or mucinous cystic neoplasm.

Conclusions: Cystic changes of pancreas solid tumors are extremely rare. However, the possibility of cystic manifestation of pancreas solid tumors should be kept in mind.

Figure 1

PDAC with cystic degeneration. (a) CT shows huge cystic pancreas mass in tail portion. (b,c) Macroscopic appearance of the tumor showing big degenerative cyst which wall is severly thickened. (d,e) Microscopic finding of tumor wall contains cancer cell with poorly differentiation.

Figure 2

Solid pseudopapillary tumor with cystic degeneration. (a) CT shows cystic mass in pancreas head portion. (b-d) Gross appearance with cyst contains chocolate like materials suggestive with necrotic debrids.