Case Report
Copyright ©The Author(s) 2015.
World J Gastroenterol. Sep 7, 2015; 21(33): 9793-9802
Published online Sep 7, 2015. doi: 10.3748/wjg.v21.i33.9793
Table 2 Differential diagnoses of cystic and cystic-solid lesions of pancreas
Cystic lesionsSex/age/size/siteImaging, cytology features
PseudocystsAnyUnilocular
Serous cystic neoplasmsF/60s/large/body or tailSerous and mucinous cystadenoma similar on CT
Central fibrous scar with calcification
Septation
Multiple cysts lined by glycogen-rich epithelial cells that are positive for periodic acid Schiff and express cytokeratins
Mucinous cystic neoplasmsF/50-60s/> 10 cm/body or tailSingle multilocular cysts that do not communicate with the ductal system
Smooth shape, even wall, with or without (fine) septa with potential small nodules
Peripheral egg shell calcification
Cyst lined by columnar mucin-producing epithelial cells set within an ovarian-like stroma
Dysplasia and malignant potential
Express keratin, carcinoembryonic antigen and CA19-9, while CK20 and CDX2 (markers of intestinal differentiation) are negative
IPMNM = F/70-80s/headIntraductal proliferation of mucinous cells usually showing papillary projections
Dysplasia, invasion and malignant potential
The epithelium of IPMNs expresses keratins, CEA and CA19-9, with variable expression of MUC
Solid pseudopapillary neoplasmsYoung F/> 10 cm/tail, headSolid or cystic-solid hypervascular tumors, solid part enhances
Show pseudopapillae and pseudocysts
Stain for vimentin and beta catenin with partial reactivity to keratin
CD56 and synaptophysin stains may be positive, chromogranin negative
Cystic change of solid tumorsPDAC is rare < 50, M = FRecognition of adjacent solid lesion (carcinoma) is the key to correct diagnosis of ductal adenocarcinoma
PDAC are fibrotic, hypo-vascular, ill defined border, early infiltration in peri-pancreatic fat, invasion of vascular structures and ducts
NET and Islet cell tumors are hyper-vascular and hyper-enhancing with positive staining for chromogranin and synaptophysin
Lymphoepithelial cystsM/50-60s/ body or tailLined by squamous epithelium and surrounded by dense lymphoid tissue, possibly showing germinal centers
Vascular tumors (Lymphangiomas, hemangiomas, hemolymphangioma, hemangioendothelioma, angiosarcomaF > M/largeCystic-solid, encapsulated, multi-loculated, micro-cystic portions appear solid and enhancing
Vascular markers CD31, CD34 and factor VIII are positive in endothelial cells
Cytokeratins neg
Lymphatic marker D2-40 neg in hemangioma, positive in lymphangioma
Angiosarcomas, highly aggressive, a vascular channel lined by variably atypical endothelial cells
Metastatic from renal cell cancerHypervascular, invasive
Accessory splenic tissueTailhypervascular
OthersRare solid tumors of the pancreas also include: mature teratoma, hamartoma, sarcoidosis, yolk sac tumor, acinar cell carcinoma, lymphoplasmatic sclerosing pancreatitis, primary pancreatic lymphoma., duodenal tumor, duplication cysts, paraganglioma, cystic GIST, glomus tumor, etc.