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Pancreatic cystic lesion
AbdomenCT / MRI (MRCP)
A cystic pancreatic lesion. Communication with the duct, cyst architecture and demographics separate benign from mucinous (premalignant) lesions.
Differential
Serous cystadenoma
common- •Microcystic "honeycomb" with a central stellate scar/calcification
- •Older woman ("grandmother"); no duct communication
Branch-duct IPMN
common- •Cyst COMMUNICATES with the main pancreatic duct
- •Grape-like clusters, often uncinate; elderly
- •Worrisome: mural nodule, duct >5 mm
Mucinous cystic neoplasm
common- •Macrocystic with peripheral eggshell calcification
- •Body/tail of a middle-aged woman ("mother"); no duct communication
Pseudocyst
less-common- •Prior/current pancreatitis; thick enhancing wall, no epithelium
- •May contain debris; peripancreatic fat changes
Solid pseudopapillary neoplasm
rare- •Large encapsulated mixed solid-cystic mass with haemorrhage
- •Young woman ("daughter")
Cystic neuroendocrine tumour
rare- •Hypervascular enhancing rim/solid component
- •May be functioning; MEN1 association
Key discriminators
- •Communication with the pancreatic duct (IPMN)
- •Micro- vs macrocystic architecture
- •Central scar (serous) vs peripheral eggshell calcification (mucinous)
- •Demographics (grandmother/mother/daughter rule)
- •Worrisome features: mural nodule, thick septa, main-duct dilatation
Work-up / next steps
- 1.MRI/MRCP to assess duct communication and internal architecture
- 2.Apply Fukuoka/European guidelines for worrisome/high-risk stigmata
- 3.EUS with fluid CEA/cytology for indeterminate mucinous lesions
- 4.Surveillance vs resection per risk stratification
References
- Tanaka M et al. Fukuoka consensus guidelines. Pancreatology.
- Radiopaedia: Pancreatic cystic lesions.
Educational clinical decision support only. This differential does not make a diagnosis, is not a medical device, and must never substitute for interpretation by a qualified radiologist correlated with the full clinical picture and prior imaging.