Pancreatic Tumors

• Pancreatic Tumors


  Classification of pancreatic tumors
• Types of benign lesions


  • Benign
  • Premalignant
  • Intraductal Papillary Mucinous Neoplasia (IPMN)
  • Mucinous Cystic Neoplasia (MCN)
  • Solid Pseudopapillary Neoplasia (SPEN)
  • True Benign/ Noncancerous
  • Pseudocysts
  • Serous Cystic Neoplasia (SCN)
  • Choledochal cysts, amoebic cysts, lymphoreticular cysts, and post-traumatic cysts
• Premalignant conditions


  Conditions that may lead to cancer
• Increasing incidence of pancreatic cysts due to better imaging leading to more incidental diagnoses
• Pancreatic cysts are more common in older patients (0% <40yo, 8.7% >80yo)
• Main differential diagnosis for pancreatic cysts


  • Malignant versus non-malignant
  • Mucinous versus serous
• Imaging to determine


  1. Communication with main pancreatic duct

  2. Size and number of cysts

  3. Mural nodules

  4. Other characteristic features
• Intraductal Pancreatic Mucinous Neoplasm (IPMN)


  Represents a pancreatic "field defect" with the epithelium being prone to dysplastic changes, development of multifocal IPMN and anywhere else in the pancreas must be considered
• IPMN types


  • Main duct
  • Side branch
  • Mixed
• IPMN lifetime risk of malignancy


  • Main duct 40%
  • Side branch 25%
• Mucinous Cystic Neoplasia (MCN)


  Characterized by estrogen and progesterone receptor positive ovarian-like sub-epithelial stroma, occur almost exclusively in women
• MCN classification


  • Benign mucinous cystadenomas
  • Borderline mucinous cystic neoplasms
  • Mucinous cystadenocarcinomas
• No recurrence of MCN or malignancy in all except mucinous cystadenocarcinomas with invasion
• Solid Pseudopapillary Neoplasia (SPEN)


  Uncertain histogenesis, occur mostly but not exclusively in young women, highly variable morphology with cystic and solid parts, low malignant potential but 15% develop metastatic disease, 97% 5-year survival even with disseminated disease
• Serous Cystic Neoplasia (SCN)


  15-20% of cystic neoplasms of the pancreas, 75% occur in females, thought to be benign
• SCN subtypes


  • Serous-microcystic adenoma (SMA)
  • Serous-oligocystic adenoma (SOIA)
  • Von Hippel-Lindau-associated adenoma (VHL-ZA)
• SMA is the most frequent SCN subtype (>60%) and found in elderly women, can present as microcystic, oligocystic or macrocystic variants
• Take home messages


  • Classical cyst features
  • Pre-malignant and malignant cysts
  • Post resection follow-up is required
  • At least 5-7yrs of non-resected cyst follow-up
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• Locations of cancers

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