Serous pancreatic neoplasia, data and review

Abstract

Aim: To describe the imaging features of serous neoplasms of the pancreas using ultrasound, endoscopic ultrasound, computed tomography and magnetic resonance imaging.

Methods: This multicenter international collaboration enhances a literature review to date, reporting features of 287 histologically confirmed cases of serous pancreatic cystic neoplasms (SPNs).

Results: Female predominance is seen with most SPNs presenting asymptomatically in the 5^th through 7^th decade. Mean lesion size was 38.7 mm, 98% were single, 44.2% cystic, 46% mixed cystic and solid, and 94% hypoechoic on B-mode ultrasound. Vascular patterns and contrast-enhancement profiles are described as hypervascular and hyperenhancing.

Conclusion: The described ultrasound features can aid differentiation of SPN from other neoplastic lesions under most circumstances.

Keywords: Cancer; Elastography; Endoscopic ultrasound; Guideline; Ultrasound.

Figure 1

Macro- and micro-pathology (histology, cytology) of microcystic pancreatic adenoma. A: Typical microcystic appearance of serous cystadenoma with “honeycomb” architecture, and central scar with small calcification; B: Histology demonstrates the typical single layer of clear cuboidal epithelial cells lining the cysts.

Figure 2

Typical microcystic serous pancreatic neoplasia using colour Doppler imaging. Note the centrally located artery.

Figure 3

Typical microcystic serous pancreatic neoplasia using B-mode (A), colour Doppler imaging (B), and contrast enhanced ultrasound (C and D). Note the centrally located artery and the typical hyperenhancement.

Figure 4

Typical oligocystic serous pancreatic neoplasia using endoscopic ultrasound.

Figure 5

Histopathologically proven serous microcystic serous pancreatic neoplasia. A: A solid-cystic lesion was detected in the head of pancreas with B-mode ultrasound; B: Multiple interlesional color flow signals were detected using colour Doppler imaging; C: Contrast enhanced ultrasound showed the lesion to hyperenhance in the arterial phase; D: Isoenhance in the late phase; E and F: Surgical pathology shows the typical honeycomb structure.

Figure 6

Pseudo-solid serous pancreatic neoplasia, histologically demonstrated to have a microcystic structure. A: B-mode ultrasound shows a solid hypoecoic mass in the neck of the pancreas; B: Contrast enhanced ultrasound shows the lesion to hyperenhance with a hypoechoic defect in the center; C: Computed tomography shows the lesion as solid and inhomogeneously hyperenhancing.

Figure 7

Large pseudosolid serous pancreatic neoplasia. A: With B-mode ultrasound a huge mass is visible appearing solid and inhomogeneously hypoechoic; B: Doppler shows large arterial vessels within the mass; C: With Computed tomography the lesion appears pseudosolid with inhomogeneous slight enhancement; D: Magnetic resonance imaging clearly shows the cystic nature of the mass with microcystic appearance.

Figure 8

Unilocular serous pancreatic neoplasia. A: B-mode ultrasound shows a cyst in the body of the pancreas; B: Magnetic resonance imaging shows small cystic lesions in the body of the pancreas not communicating with the main pancreatic duct.