Intraductal papillary mucinous neoplasm - side branch type (CT)

Case contributed by Henry Knipe


Follow-up from clinic.

Patient Data

Age: 70 years
Gender: Female

Multifocal (around 8) non-enhancing low density lesions throughout the pancreas, some of these communication with the pancreatic duct. Pancreatic duct is prominent in relationship to lesions in the distal pancreatic tail, pancreatic neck and head. Background pancreas is unremarkable with a single calcification. No lymphadenopathy.

Left simple renal cysts. Cholelithiasis.

Case Discussion

Intraductal papillary neoplasms (IPMN) can be of two types - main duct and branch duct. This is the latter with small cystic lesions, and the key to diagnosis is recognizing communication with the main duct. Multifocal IPMN has, unsurprisingly, increased risk of malignant transformation. Imaging features suggestive of that include:

  • increased size >3 cm
  • nodules > 2 mm
  • enhancing nodules or septations
  • dilated main pancreatic duct

In this case, the lesions had grown slightly over 3 years with a few new lesions. There has been no further characterization with MRI, and surgery/biopsy has not been performed. 

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