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Cystic pancreatic lesions are increasingly identified due to the widespread use of CT and MRI. Certain pancreatic cysts represent premalignant lesions and may transform into mucin-producing adenocarcinoma. Although the overall risk of malignancy is very low, the presence of these pancreatic cysts is associated with a large degree of anxiety and further medical investigation due to concerns about malignancy. In larger cystic lesions it is usually possible to differentiate between benign serous cystadenomas and premalignant mucinous cystic neoplasms and intraductal pancreatic mucinous neoplasms, but in small lesions characterization is often not possible. When a cystic pancreatic lesion is detected, the first step is to decide whether the lesion is most likely a pseudocyst or a cystic neoplasm. This scheme is a simplified roadmap for the differentiation of pancreatic cysts. Pseudocyst - Think pseudocyst when there is a history of chronic or acute pancreatitis,  [[https://69.cholteth.com/index/d1?diff=0&utm_source=ogdd&utm_campaign=26607&utm_content=&utm_clickid=g00w000go8sgcg0k&aurl=http%3A%2F%2Fchessdatabase.science%2Fwiki%2FIntroducing_Alpha_Surge_Male%3A_Your_Ultimate_Testosterone_Support_And_Performance_Booster&pushMode=popup|buy alpha surge male]] alcohol abuse, stone disease or abdominal trauma. Findings suggestive of chronic pancreatitis may be parenchymal or ductal calcifications and peripancreatic fat-infiltration.


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Cystic neoplasm- No history of pancreatitis or trauma, or when the cyst has internal septa, a solid component, central scar or wall calcification. Mucinous cystic neoplasm - This is usually a unilocular cyst filled with mucin sometimes with wall calcification, exclusively seen in predominantly 40 - 60 year old women. They are often located in the body or tail and are characterized by ovarian type stroma in the pathological evaluation. Serous cystic neoplasm - This is most often a microcystic lesion that contains serous fluid. Branch-duct IPMN - This tumor can look like a SCN, but has no scar or calcifications. MRCP or heavily weigted T2WI may show the connection to the pancreatic duct, which is highly specific, but in many cases we are not able to detect this communication. The left CT-image is of a patient with a history of pancreatitis. There are two unilocular or  [[https://wiki.internzone.net/index.php?title=How_To_Gain_Weight_Fast:_7_Secrets_For_Skinny_Guys|buy Alpha Surge Male]] simple cysts. Notice also the retroperitoneal fat-stranding on the right. The most likely diagnosis is pseudocysts.



The CT on the right shows a cyst in the pancreatic tail in a 36 year old woman, which was found incidentally with US. The cyst has a thick irregular rim and contains solid 'non-dependent' components. The most likely diagnosis is a cystic neoplasm. CT will depict most pancreatic lesions, but is sometimes unable to depict the cystic component. MR with heavily weighted T2WI and MRCP will better demonstrate the cystic nature and the internal structure of the cyst and has the advantage of demonstrating the relationship of the cyst to the pancreatic duct as is seen in IPMN. The images show a serous cystic neoplasm (SCN) on a CT. MRI better shows the central scar. There are cases when CT can be helpful, since it better depicts a central calcification in SCN or peripheral calcification in a mucinous cystic neoplasm (MCN). CT images of a mucinous cystic neoplasm with septations and peripheral calcifications. MRI is usually of more diagnostic value than CT.



MRI can show the cystic nature of a pancreatic fluid collection and its internal structure. MRI shows a lesion, which consists of multiple small cysts. This could be a serous cystic neoplasm or a branch-duct IPMN. The connection of the cystic lesion to the pancreatic duct indicates that this is a branch-duct IPMN. Unilocular cyst without solid components, central scar or wall calcification. Collection of pancreatic enzymes, blood and necrotic tissue. Debris within a cystic lesion is a specific MR finding. History of pancreatitis or abdominal trauma. Cysts develop in 4-6 weeks - usually decrease in size over time - sometimes enlarge or become infected. Found in any part of the pancreas or anywhere within the abdomen and sometimes even in the chest. The CT demonstrates a large cyst in the upper abdomen in a patient who had an acute pancreatitis (Fig). Notice that there is also some ascites and pleural fluid. There is wall enhancement. CT demonstrates two large cysts in a 45 year old woman, who had a trauma (fig).



Notice some fat stranding in the retroperitoneal space (arrow). The imaging findings combined with the history make it very likely that these are traumatic pseudocysts. Most pseudocyst occur in the peripancreatic region, but rarely they may extend to the mediastinum. Scroll through the images. This patient has a chronic pancreatitis. Notice the calcifications in the pancreatic head (curved arrow). There are multiple pseudocysts extending all the way to the mediastinum compressing the heart (red arrow). The diagnosis of a cystic neoplasm should be considered when there is no history of pancreatitis or trauma. In the Table some discriminating features of cystic neoplasms. In many cases however it is not possible to make a definitive diagnosis, because often the cyst will be too small. However it is important to diagnose a serous cystic neoplasm, since this is the only tumor with no malignant potential. When there are symptoms it is due to increasing size. MCN is exclusively seen in middle-aged women with a mean age of 47 years (8) .