Imaging pitfalls of pancreatic serous cystic neoplasm and its potential mimickers

Figure 9 A 74-year-old male with microcystic serous cystic neoplasm mischaracterized as intraductal papillary mucinous neoplasm with a solid component. A: The pancreatic parenchymal phase of an axial contrast enhanced-computed tomography shows a cystic lesion with an enhancing component (arrow) in the pancreatic tail; B: Magnetic resonance cholangiopancreatography (MRCP) shows the cystic lesion to be elongated, and the upstream main pancreatic duct (MPD) appears to be dilated (arrow). There is no dilatation of the downstream MPD. The extrahepatic bile duct is tortuous, likely due to distal gastrectomy (Billroth I reconstruction); C: Endoscopic retrograde pancreatography shows the cystic lesion to be unopacified. There is no communication with the pancreatic duct or upstream MPD dilatation. MRCP findings eventually represented a part of the cystic lesion along the course of the pancreas rather than MPD dilatation (arrow, B); D: Macroscopic view of the resected specimen (short axis cut section) shows the cystic lesion consisting of microcysts and fibrosis (arrow).