Mucinous cystadenocarcinoma of the pancreas
Like the more benign mucinous cystadenomas, these are found almost exclusively in females 4.
It is typically seen as a cystic pancreatic lesion with cysts that are less numerous and larger in size (with an average diameter of ~10-12 cm) than typically observed with serous cystadenomas/cystadenocarcinomas. Its external surface is often smooth, and it is composed of unilocular or multilocular large (>2-4 cm) cysts with a thicker wall 5.
On CT, they tend to appear as round to ovoid, externally smooth, near-water-density cystic lesions. Amorphous calcifications, septations and solid excrescences may be seen. Both mucinous cystadenomas and cystadenocarcinomas do not have central scars.
Signal characteristics of the cyst(s) can vary dependant on content. Mucin components exhibit high signal on T1 while calcific components are low signal on both T1 and T2 10. Pure cystic components show low signal on T1 and high signal on T2.
Treatment and prognosis
While surgical resection is the standard mode of treatment, even the overtly malignant mucinous cystadenocarcinomas carry a far better prognosis than solid ductal adenocarcinomas 1.
On ultrasound or CT consider
- serous cystadenoma of the pancreas: can sometimes be indistinguishable on imaging 3
- cystic neoplasm (cystic pancreatic mass differential diagnosis)
- solid neoplasm
- nonepithelial pancreatic neoplasms
pancreatitis (mnemonic for the causes)
- gallstone pancreatitis
- interstitial oedematous pancreatitis
- necrotising pancreatitis
- haemorrhagic pancreatitis
- revised Atlanta classification of acute pancreatitis
- chronic pancreatitis
- Ascaris-induced pancreatitis
- tropical pancreatitis
- autoimmune pancreatitis
- emphysematous pancreatitis
- hereditary pancreatitis
- pancreatitis associated with cystic fibrosis
- segmental pancreatitis
- acute pancreatitis
- pancreatic atrophy
- pancreatic lipomatosis
- pancreatic trauma
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- 2. Inceoglu R, Dosluoglu H, Okboy N et-al. Mucinous cystadenocarcinoma of the pancreas: an uncommon presentation with anaemia and upper gastrointestinal bleeding. J R Soc Med. 1991;84 (3): 171-2. - Free text at pubmed - Pubmed citation
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- 4. Buetow PC, Rao P, Thompson LD. From the Archives of the AFIP. Mucinous cystic neoplasms of the pancreas: radiologic-pathologic correlation. Radiographics. 18 (2): 433-49. Radiographics (abstract) - Pubmed citation
- 5. Kalra MK, Maher MM, Mueller PR et-al. State-of-the-art imaging of pancreatic neoplasms. Br J Radiol. 2003;76 (912): 857-65. doi:10.1259/bjr/16642775 - Pubmed citation
- 6. Thompson LD, Becker RC, Przygodzki RM et-al. Mucinous cystic neoplasm (mucinous cystadenocarcinoma of low-grade malignant potential) of the pancreas: a clinicopathologic study of 130 cases. Am. J. Surg. Pathol. 1999;23 (1): 1-16. Am. J. Surg. Pathol. (link) - Pubmed citation
- 7. Ros PR, Mortele KJ. CT and MRI of the abdomen and pelvis, a teaching file. Philadelphia, PA : Wolters Kluwer Health/Lippincott Williams & Wilkins, c2007. (2006) ISBN:0781772370. Read it at Google Books - Find it at Amazon