Intraductal papillary mucinous neoplasms - side branch type

Case contributed by Dr Mostafa El-Feky

Presentation

Incidentally noted multiple pancreatic cystic lesions on ultrasonography

Patient Data

Age: 40 years
Gender: Male

Multiple (>10) cystic pancreatic lesions noted showing the following details:

  • location: head, body and tail
  • size: 3 mm up to 3.2 cm (the largest is in the head)
  • wall (thickness/enhancement): thin/imperceptible, non-enhancing
  • septa: thin
  • solid nodules: absent
  • communication with pancreatic duct: present
  • main pancreatic duct: caliber= 1.5 mm, no segments of dilatation
  • background pancreatic parenchyma: normal
  • CBD: normal, no dilatation
  • related adenopathies: absent

Case Discussion

The imaging features are those of multiple side-branch IPMNs. No main ductal involvement. Branch duct type of intraductal papillary neoplasms (IPMN) appear as small cystic lesions with a bunch of grapes appearance. The key to the diagnosis is to recognize a communication with the main duct. The only worrisome feature, in this case, is the largest cyst measuring > 3 cm. No other high-risk stigmata.

Multifocal IPMN has 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

Case courtesy, Prof.Dr. Mohamed Eid, Professor of Radiology, Alexandria university, Egypt.

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