Multifocal branch duct intraductal papillary mucinous neoplasm
Follow-up from clinic.
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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.
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 recognising communication with the main duct. Multifocal IPMN have, 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 characterisation with MRI, and surgery/biopsy has not been performed.