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©2012 Baishideng Publishing Group Co.
World J Gastrointest Endosc. Jun 16, 2012; 4(6): 247-259
Published online Jun 16, 2012. doi: 10.4253/wjge.v4.i6.247
Published online Jun 16, 2012. doi: 10.4253/wjge.v4.i6.247
Table 1 Cystic lesions of the pancreas[19] (reprinted with permission of Dr. Parra-Herran CE)
Cystic lesions of the pancreas |
Non-neoplastic cysts (30%-40%) |
No lining |
Inflammatory pseudocyst |
Paraduodenal wall cyst |
Infection-related cyst |
True lining |
Mucinous non-neoplastic cysts (mucoceles, retention cysts) |
Cystic hamartoma |
Enterogenous (congenital, duplication) cyst |
Endometriotic cyst |
Lymphoepithelial cyst |
Squamoid cyst of pancreatic ducts |
Others (unclassified) |
Neoplastic cysts (60%-70%) |
True lining |
Mucinous lining (30%) |
Intraductal papillary mucinous neoplasm (20%) |
Mucinous cystic neoplasm (10%) |
Serous lining (20%) |
Serous cystadenoma (microcystic, oligocystic) |
Von Hippel-Lindau-associated pancreatic cyst |
Serous cystadenocarcinoma |
Squamous lining (< 1%) |
Epidermoid cyst within intrapancreatic accessory spleen |
Dermoid cyst |
Acinar cell lining (< 1%) |
Acinar cell cystadenoma |
Acinar cell cystadenocarcinoma |
Endothelial lining (< 1%) |
Lymphangioma |
Solid tumors with cystic change (5%) |
Solid pseudopapillary tumor |
Ductal adenocarcinoma with cystic change |
Neuroendocrine tumor with cystic change |
Other invasive carcinomas with cystic change |
No lining (< 1%) |
Mesenchymal neoplasms with cystic change |
Others (unclassified) |
Table 2 Major features of four most common cystic lesions
Table 3 Endoscopic ultrasound morphology and cystic fluid analysis in pancreatic cystic lesions
Serous cystoadenoma | Mucinous cystic neoplasm | BD-IPMN | Pseudocyst | |
Localization | ||||
Head | +++ | +/- | +++ | ++ |
Body-tail | ++ | +++ | ++ | ++ |
Locularity | ||||
Unilocular | + | + | + | +++ |
Multilocular | +++ | +++ | +++ | + |
Internal structural features | ||||
Microcystic aspect | +++ | - | + | - |
Bunch of grape aspect | + | - | +++ | - |
Countors | ||||
Round | + | +++ | + | +++ |
Lobulated | +++ | +/- | + | +/- |
Irregular | +/- | - | +++ | - |
Central scar | + | - | - | - |
Visible cystic wall | - | ++ | + | +/++ |
Multifocality | - | - | ++ | +/- |
Debris | - | - | - | ++ |
Visible comunication with pancreatic duct | - | - | ++ | + |
Calcification | ||||
Central | + | - | - | - |
Periphery | - | + | - | +/- |
Solid lesion | - | + | + | - |
CEA | ||||
≥ 192 mg/mL | +/- | ++ | ++ | +/- |
≥ 5 mg/mL | + | +++ | +++ | ++ |
≤ 5 mg/mL | +++ | +/- | +/- | + |
Amylase | ||||
> 250 U/L | + | +/++ | ++/+++ | +++ |
K-RAS mutation | - | ++ | ++ | - |
Mucin | - | + | + | - |
Cytology | Glycogen | Mucinous | Mucinous | Inflammatory |
Table 4 Accurancy of endoscopic ultrasound morphology in differentiating pancreatic cystic lesions (printed with permission of Dr M. Raimondi
Author | No. of patients | Study design | Accuracy (%) |
Koito et al[57] | 52 | Retrospective | 94 |
Cellier et al[64] | 21 | Retrospective | 76 |
Pais et al[54] | 51 | Retrospective | 86 |
Ahmad et al[60] | 38 | Retrospective | 66 |
Sedlack et al[42] | 34 | Retrospective | 82 |
Hernandez et al[58] | 9 | Retrospective | 89 |
Frossard et al[59] | 67 | Retrospective | 73 |
Brugge et al[61] | 112 | Prospective | 51 |
Gerke et al[62] | 66 | Retrospective | 67 |
Total | 450 | Median 72.5 (mean 77) |
- Citation: Barresi L, Tarantino I, Granata A, Curcio G, Traina M. Pancreatic cystic lesions: How endoscopic ultrasound morphology and endoscopic ultrasound fine needle aspiration help unlock the diagnostic puzzle. World J Gastrointest Endosc 2012; 4(6): 247-259
- URL: https://www.wjgnet.com/1948-5190/full/v4/i6/247.htm
- DOI: https://dx.doi.org/10.4253/wjge.v4.i6.247